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Re: Metronidazole/Tetracycline
Posted: Thu Apr 01, 2021 2:20 pm
by Crawler
Brownchikano wrote: ↑Thu Apr 01, 2021 2:12 pm
Crawler wrote: ↑Thu Apr 01, 2021 1:07 pm
Resistance to Metronidazole is high in this area, around 50%, and low to tetracycline. They prescribe rifabutin only for Tuberculosis.
What area is that?
Southeastern Europe, Balkan.
Re: Metronidazole/Tetracycline
Posted: Thu Apr 01, 2021 5:31 pm
by Crawler
Helico expert
Could you please write if there is difference in cure rate between 10 and 14 days of PBMT regime with previous metronidazole resistance?
Re: Metronidazole/Tetracycline
Posted: Thu Apr 01, 2021 6:58 pm
by Crawler
Crawler wrote: ↑Thu Apr 01, 2021 5:31 pm
Helico expert
Could you please write if there is difference in cure rate between 10 and 14 days of PBMT regime with previous metronidazole resistance?
P. S. Unfortunately, tetracycline is unavailable. What about doxycicline instead tetracycline? Is there another efficient regime with penicilin allergy?
Re: Metronidazole/Tetracycline
Posted: Fri Apr 02, 2021 12:11 am
by Crawler
So, my friend spoke to his GI and he proposed doxycycline instead tetracycline, since tetracycline is unavailable. Here's regimen:
Rabeprazole 20 mg TID
Bismuth subcitrate 120 mg QID
Doxycycline 100 mg BID
Metronidazole 400 mg TID
All of this for 14 days. Do you think that this therapy is a good choice? Do you have insights when doxycycline is used instead tetracycline? Does doxycycline overcome metronidazole resistance when used together?
His first regime failed: CLarythromicin and Metronidazole 14 days.
P. S. Is it true that Rabeprazole and Metronidazole together is a bad combination due to antagonism?
https://www.karger.com/Article/Abstract/226426
Re: Metronidazole/Tetracycline
Posted: Sat Apr 03, 2021 9:55 am
by Helico_expert
Unfortunately I dont have the data for the cure rate of 10 days vs 14 days. it's probably 90% vs 94%.
According to Prof Marshall, tetracycline works better than Doxycycline. But when you have no choice, doxycycline should do the job too.
Rabeprazole should works fine with metronidazole. There are articles that support both antagonism and synergism of these two drugs.
Nevertheless, perhaps it's a better idea to avoid using metronidazole and replace by rifabutin or ciprofloxacin.
Re: Metronidazole/Tetracycline
Posted: Sat Apr 03, 2021 3:17 pm
by Crawler
Helico_expert wrote: ↑Sat Apr 03, 2021 9:55 am
Unfortunately I dont have the data for the cure rate of 10 days vs 14 days. it's probably 90% vs 94%.
According to Prof Marshall, tetracycline works better than Doxycycline. But when you have no choice, doxycycline should do the job too.
Rabeprazole should works fine with metronidazole. There are articles that support both antagonism and synergism of these two drugs.
Nevertheless, perhaps it's a better idea to avoid using metronidazole and replace by rifabutin or ciprofloxacin.
However, it is possible to buy tetracycline. Since his doctor is a new graduate, he suggested bismuth quadruple therapy because he has no experience with others. He said the chances of him succeeding are small because he has used metronidazole 5 times in the last 6 years. So, what other antibiotics with tetracycline have good cure rates?
You mentioned ciprofloxacin instead of metronidazole, do you have experience with this combination and what are the doses? Are the side effects of ciprofloxacin greater than metronidazole? Furazolidone and rifabutin are not available here.
Resistance percentage in this area:
Clarythromycin(63,3 %) Metronidazole (60,3 %), Levofloksacin 11,6 %, Rifampicin 4,1 %, Amoxicilin and Tetracycline 0%.
Do you think that a high dose of PPI (Rabeprazole 20 mg TID) and METRONIDAZOLE (500 mg TID) with Tetracycline could overcome Metronidazole high resistance in this area (60 %)? Is that even possible with such high resistance?
Re: Metronidazole/Tetracycline
Posted: Sun Apr 04, 2021 9:08 pm
by Helico_expert
The theory is that H. pylori is very difficult to develop resistance to Tetracycline. So even if this treatment failed, you can still use Tetracycline with other antibiotics. That is if you want to give PBTM a try.
PBTM = PPI + Bismuth + tetracycline + metronidazole
However, if you want to switch to other combinations, eg.
PBTR = PPI + Bismuth + tetracycline + rifabutin
PBTC = PPI + Bismuth + tetracycline + ciprofloxacin
PBRC = PPI + Bismuth + rifabutin + ciprofloxacin
All the above have good cure rate.
**********************************************
Rifabutin 150 mg BID
Ciprofloxacin 500 mg BID
Re: Metronidazole/Tetracycline
Posted: Sun Apr 04, 2021 10:48 pm
by Crawler
Thank you. His doctor decided to try with PBMT, despite high metronidazole resistance. He believes that with high doses of metronidazole 500 mg TID for 14 days, excellent cure rates can be achieved. Ciprofloxacin was left as a last resort.