TREATMENT OF HPYLORI IN PT WITH MULTIPLE ALLERGIES

[RINI1378]

I have a patient with H. Pylori infection who is allergic to multiple medications and was wondering the best treatment strategy. The patient is allergic to PCN, Tetracycline, Azithromycin, Levaquin. What can I use to treat H. Pylori?

[barjammar]

That is a tough case. Bismuth does not cause allergies so start with De-Nol 120 mg 2 tabs qid for 14 days (with food or not - it does'nt matter). Then add antibiotics you can use - furazolidone might work at 100 mg tid. Also, add rifabutin 150 mg bid. Also give PPI in high dose - such as rabeprazole 20 mg tid. Side effects could be an issue with drugs, but not always. In USA you can use Pepto-Bismol tablets. There are some publications by Graham D.Y. and colleagues. Sorry I can't be more helpful. Also, if there is any chance the penicillin allergy is not real, then have an allergist confirm it before avoiding penicillin; amoxycillin is the best drug for failed treatments if you can use it.