Helicobacter Forums

After 3 failed triple therapy treatments what is the success rate of omeprazole 40mg plus amoxicillin 500mg both taken 4 times per day for 14 days?
Many thanks
siebgens

it depends on case to case, but i think the success rate is low. after the third time fail, i suggest you get endoscopy and do a more specific antibiotic sensitivity test to find out exactly what should be used for treatment.

Thanks for the reply. Have had endoscopies but was told sensitivity testing not avalaiable in UK.
siebgens

unbelievable. UK is a very developed country and such simple test should be available. perhaps the sample has to be sent into a bigger hospital or pathology lab in UK?

Dear Dr Marshall
Diagnosed H pylori+ve in 2010. and had that year 2 triple therapy of same antibiotic.(Amox/Clari/Omepr) and as still +ve (HPSA) then a 3nd triple therapy (Lanzo/amox/metron) which also failed. And was pronounced as having dual resistance Metronidazole and Clari.strains. Physician’s decision was not to treat any more as side effects would outweigh any benefits he felt.

Continued to feel very unwell(run down, no energy weakness flu-like) and gastric symptoms o fexcessive bloating burping etc. but no acid reflux.

This year asked for a second opinion, had Gastroscopy all normal but CLO test changed immediately to bright red. Now quadruple will be prescribed (Omepraz/metronidazol/tetracycl/bismuth) Had asked for sensitivity but this was not done.

Am concerned that the quadruple contains Metron. to which I was pronounced resistant in 2010. Any advice???? As I feel this is my last chance of success.
Many thanks
Bee Siebgens

I am Prof. Marshall's assistant. You are right about the Metronidazole resistance and should avoid taking the same drug. Nevertheless, there is a whole list of other antibiotics that you can use to replace Metronidazole. eg. Rifabutin, norfloxacin, etc

The treatment you mention (Om-Met-Tet-Bism) is not bad, and even met-resistant Hp can be killed by it (we don't understand why) so that the cure rate is probably more than 70%. To boost it, I would push the doses of antibiotics and have multiple frequent doses - 3 hourly for example.

Bismuth dose can be doubled - 2 tabs QID if it is Denol.
Omeprazole should be given in maximum dose - 40 mg tds would be better.
Tetracycline 500 mg qid (or 8 doses of 25 mg spread out and taken with the bismuth tabs).
Metronidazole at least 1.5 grams per day, or if 400 mg tablets take 400 mg qid (avoid alcohol).

If you can take this for 14 days, there is a good chance it will work. After that, if still positive, we have a special powerful combination available - but it is quire expensive. Let us know how it goes.

many thanks Dr Marshall for the comprehensive reply. As I am resistant to Met. would it be advisable for me to ask my Gastro to replace the Met with Amox. As I have read that Amox resistance is rare.

Would I have a better chance of eradication on Amox/Tetr antibiotic combination with the bismuth and PPI?

Yes the bismuth will be DeNol.
Many thanks
Bee Siebgens

metronidazole (MTZ) resistance can be overcome by increase the dosage. That's why Prof. Marshall suggested at least 1.5 grams MTZ per day.

Dear prof. Marshall

I have now received my H Pylori quad.meds to be taken for 14 days

My given prescription is as follows(not quite enough to follow your advice sadly)
.
DeNol 120mg 4x a day

Omeprazole 20mg 2x a day

Metronidazole 400mg 3x a day

Tetracycline 500mg 4x a day

Dispensing label instruction are not to take TET and DeNol together ??????


Doubling the dose of DeNol will cover one week..Can I take Pepto during the second week and if yes how many tabs should I take or would liquid Pepto be advisable and again how much?

Over 24 hours can I follow your suggested 3 hourly schedule as follows::


0600 DeNol-TET-OM (can I take these together? )

0900 MET

1200 DeNol-TET

1500 OM

1800 DeNol-TET-MET

2100 OM-MET

0001 DeNol-TET )


To increase my chances of successful eradication should I pre-treat with OM and/or N acetyl cysteine(read somewhere NAC may aid effectiveness of antibiotics???)
Many many thanks
Bee