Second line therapy

[antanasm]

Hi,

I was diagnosed with H-pylori in very interesting way. Blood was negative, biopsy was border line, but stool antigen was very highly positive.
My main complains are stomach pain which started 4 month ago.

1 week ago, I finished first antibiotic treatment, but problem i made few mistakes. I was on 12 day treatment.

omeprazole
20 mg once a day(must be twice) ,7 days out of 12. First 5 days was not on it at all.

clarithromycin
500 mg once a day. Now i know that it should be twice a day

amoxycillin
1,000 mg twice a day. This one was correct.

My stomach pain reduced dramatically during treatment and i was very happy. But now, 1 week after, stomach pain is coming back, feel again stomach acid. In general i little better now, then before treatment.

Don't now what to do. Run a breath test? If positive, repeat first one, because i didn't made correctly?
Or do different antibiotics treatment like:

Colloidal bismuth subcitrate
One tablet (120 mg) QID
14 days

metronidazole
250 mg QID
7 days

tetracycline
500 mg QID
7 days

omeprazole
20 mg BID
7 days

Problem is, that in Lithuania we don't have tetracycline, only it derivative doxycycline.
Thanks for help

BR
Antanas

[Helico_expert]

it's common that people feel the discomfort after treatment. it takes time for the stomach to recover back to normal even though there is no bacteria. Nevertheless, you should stop your PPI for at least 3 weeks then do a followup breath test.

if you are positive then, should not take the same antibiotics. discuss with your GP and see what's the best 2nd line available at your area.

[antanasm]

Thank's for answer, but to be informed patient - tetracycline is the same doxycycline? Or tetracycline is tetracycline ?

Antanas

[antanasm]

one more question:

If i would go for breath test(after last PPI dose) after 2 weeks(not 3 weeks) and would get positive result.
Does it mean, i have bacteria and its not necessary to wait 3 weeks?. My stomach pain is so unpleasant and would like to test and do some treatment faster.

Antanas

[Helico_expert]

to my understanding, tetracycline is a big family that include doxycycline.

if two weeks later you did another breath test and turns out positive, then it'll be positive. But I think the chance is you getting borderline positive. Then it's inconclusive if you are still infected with H. pylori. It's not good to take antibiotic blindly as it'll only build up resistance of other bacteria. I would suggest you follow the guide and wait for 3 weeks after stopping your last dose of PPI. Perhaps you'll feel better next week as your stomach is slowly recovering.

[barjammar]

Re: Second line therapy (IS TETRACYCLINE THE SAME AS DOXYCYCLINE??)
I just want to interrupt the conversation on the issue above. Although in the same group, and with identical effects in vitro, these two antibiotics work differently in humans with H.pylori. The tetracycline persists in the stomach for a longer time and probably chelates with a lot of material in the mucus layer - e.g. bismuth/PeptoBismol/DeNol. So it is a useful topical agent. Also, Hpylori only very rarely becomes resistant to it ( <1% of post treatment isolates ). Docycycline on the other hand, is very quickly absorbed so that it is not physically present in the stomach for very long. Doxycycline relies on excretion in bile and biliary recycling to give it a long action - that is why it can be a once-a-day drug. Some people have free bile reflux up from the duodenum into the stomach, in which case doxy'would be OK. However, in most people, doxy'is going to act in the intestine - and will not act in the stomach for more than an hour - or if taken with a meal - for a few hours. There no direct comparisons between the two agents but I know of some studies where doxy'failed to work.
In Australia, tetracycline can be obtained as an órphan drug' from Tri-Med ( http://www.trimed.com.au. Maybe they can send overseas - I am not sure.

[sl88er]

If some coated tablets of tetracycline hcl are proper for eradication of HP you can cheaply obtain them in Poland. Yours prescribtion will be valid in polish drugs store. Cost is about 4 € for 16 tablets 250mg... So I think it is quite inexpensive.

[antanasm]

Hi,

Thanks for replay. Is every drug store have tetracycline in Poland ?:) I live ~100km from Poland, so its not a problem to go there and buy it.
Have you been on tetracycline?

If some coated tablets of tetracycline hcl are proper for eradication of HP you can cheaply obtain them in Poland. Yours prescribtion will be valid in polish drugs store. Cost is about 4 € for 16 tablets 250mg... So I think it is quite inexpensive.

[antanasm]

I done breath pylori test today. It was 16th day after my last PPI and antibiotics.
Baseline was 1mm, after drink - 10mm. Its positive.

GP recommend for 6 week 20mg omeprozole for stomach pain. She want to repeat breath test 2 month later.
I was told if omeprozole calm stomach(no symptoms) and breath test will show decreasing pylori activity then no need to repeat antibiotics treatment.

I read that PPI and other stomach reducing medicine give better environment for pylori to grow? Is it true?

She also said, if i will need repeat treatment, i must take amoxycillin, but change clarithromycin to metronidazole.

In general, i agree, that i could wait with antibiotics treatment. give a time for probiotics to restore gut flora and so on.
but i don't believe i will feel better with pylori. I have never had stomach or acid problems at all,
and suddenly i got GERD and stomach pain.

[Helico_expert]

H. pylori actually multiply at a neutral pH. so is PPI going to help H. pylori grow? maybe. but it's also allowing all other bacteria to grow in the stomach. H. pylori probably will be out compete.

your GP is right about the clarithromycin switching to metronidazole. that's the standard treatment. if it fail, then we try for other methods.

H. pylori is the root of your problem. So I believe that eradicating it is the right way.