Helicobacter Forums

My daughter has been newly diagnosed with a positive breadth test but her symptoms are very mild with occasional gas pain for couple of hours once a month. She feels fine most of the time. She just happened to mention her symptoms to her doctor and he ordered the urea breadth test. Doctor prescribed quadruple therapy (tetracycline 2000mg , metronidazole 1000mg , omeprazole 40mg and bismuth) per day because she is allergic to amoxicillin.
My questions are :
1. should she be treated since her symptoms are so mild and occasional??
2. How accurate is the urea breadth test?
3. Should she do a stool test to confirm before starting the treatment? I am worried about the potential side effects and the possibility of high doses of antibiotics wrecking her microbiome. Will also give her probiotics during and after treatment to replenish gut flora. Expert advice is greatly appreciated.

1. should she be treated since her symptoms are so mild and occasional??
If she is positive of HP, she should be treated to get rid of it. Dont wait till the damage becomes permanent. Then it may be too late.

2. How accurate is the urea breadth test?
Breath test is usually very accurate. With sensitivity and specificity over 95%. However, if you can get the raw data, the higher the value, the more accurate it is. For example, if the cut off is 4% (C13 breath test) or 100 dpm (C14 breath test), and your breath test value is 10% or 2000 dpm, then it is very accurate. if your breath test value is like 4.5% or 110 dpm, then it is like maybe positive, maybe false positive.

3. Should she do a stool test to confirm before starting the treatment?
If your breath test value is high like what I mentioned above, then there is no need a second confirmation. If you got the borderline positive value, then a second test is recommended.

Thank you very much for your reply! Unfortunately we were not given any raw data by the lab. The lab result only indicated “pos”.

I have 2 more questions please:

1. Doctor prescribed 524 mg of bismuth subsalicylate 4 times a day. Is 524 mg too much per dose? I read on this website that the standard protocol is 262 mg per dose?

2. Is it okay to take the bismuth and the antibiotics all at the same time? The pharmacist said it is okay to take all at the same time but I read that it might be more effective to take the bismuth first then wait 30 minutes to take the antibiotics. Please devise.
Thank you in advance!

524 mg is double what we prescribe. But according to drugs.com, you can take up to 8 dose per day of this strength.
https://www.drugs.com/dosage/bismuth-subsalicylate.html

It's ok to take bismuth together with antibiotics. Bismuth only coat your stomach and intestine. So bacteria cannot survive. The antibiotics are absorbed in your body and flow through your body via blood supply. So all bacteria hiding deep in tissue will be killed. So you can take them together.

Can you look for a pathology lab that can give you a breath test result more than just "pos" or "neg"?

Really appreciate all of your answers. I am sorry I have to ask again because I just read this on drugs.com:

Using bismuth subsalicylate together with tetracycline may decrease the effects of tetracycline. Administration of tetracycline and bismuth subsalicylate should be separated by two to three hours. If your doctor does prescribe these medications together, you may need a dose adjustment or special test to safely use both medications.

So is it okay to take bismuth and tetracycline at the same time based on actual clinical results even the drug.com indicates it may decrease the effectiveness of tetracycline.

Thank you again for your clarification.

yea.. it's fine. We have use it together with Tetracycline and have good cure rate against H. pylori.

Thank you so much! Really appreciate all of your expert advice!
We have decided to start treatment since the doctor is not willing to order a stool test to confirm the “pos” urea test and we were unable to get the breath test raw data from the lab.

Hope all goes well.. thank you again!

Hi Helico Expert,
I have another question. What is the best way to take the quadruple therapy??
2 pharmacist tells us differently. One told us to take all 4 at the same time on empty empty stomach, then wait at least 30 minutes to eat (at least the 2 times with the omeprazole). Then the other 2 times without the omeprazole, should take the antibiotics and bismuth at least 30 minutes after meals or on empty stomach.
However, when we called back, another pharmacist’s instruction is to take the omeprazole first then wait at least 30 minutes before eating, then can take the antibiotics and bismuth with meals or right after meals.

Does it matter if antibiotics and bismuth should be taken with or without food? Can we take all 4 medications together?

Here is what the doctor rx’d: he has no instruction and told us to ask the pharmacist;

Tetracycline 500 mg QID
Metronidazole 250 mg QID
Bismuth 524 mg QID
Omeprazole 20 mg BID

Appreciate your clarification on the best way to take them.
Thank you again.

There is actually no difference taking antibiotics with or without food.
But Prof Marshall likes the patients to take it with food as he believes that the food can keep the antibiotics in the stomach longer.

Anyway, I believe that the best way is take the medicines as spread out as possible to maintain constant drug concentration in the blood.
For example, if you were to take omeprazole 2 times a day, take it every 12 hours, if you were to take Tetracycline 4 times a day, take it every 6 hours.

It doesnt matter if the tablets were taken together or 30 min apart. They (except bismuth) will be absorbed into your blood stream and kill HP when they are extracting nutrient from the cells.

another tip. The higher the PPI (omeprazole) dose, the better. And taking it 2 times a day is better than 1 time a day; and 3 times a day is better than 2 times a day.

Thank you so much for your quick reply with clarification. We greatly appreciate your service. Will report back regarding the treatment process!