Previous Antibiotic Exposure?

[Glorybee]

Hi there,
H.Pylori positive stool test on Sept 2022. And had 2 endoscopies since and also 2 lots of antibiotic treatment. And still testing positive.
Initial symptoms that alerted her GP to checking for H.Pylori - Chronic burping and pain in upper left quadrant, more uncomfortable feeling and nausea and weight loss.

Treatment and Results
Persistent H.pylori infection despite triple and quadruple therapies
- H.pylori stool antigen positive on Sept 22
- Completed 14 day course of triple therapy including Amoxicillin and Clarithromycin in November 2022
- Gastroscopy on Dec 22 reported mild gastritis
- Gastric body biopsies reported mild chronic gastritis
- H.pylori culture did not isolate H.pylori after 10 days
- H.pylori stool antigen positive on Feb 23
- Prescribed 14 day course of quadruple therapy including Amoxicillin, Tetracycline and Gastrodenol in March 2023
- H.pylori stool antigen positive on Jul 23
- Gastroscopy on Aug 2023 – reported mild gastritis in fundus
- Gastric body biopsies taken from the gastric body and gastric antrum were normal
- H.pylori culture did not isolate H.pylori after 10 days (specialist advised had taken 8 biopsies)
- H.pylori stool antigen positive on Aug 23

Compliance of the treatments – Triple therapy, took first dose and house came down with a stomach bug, tried to take second dose and doctor advised to wait a few weeks. Then took full dose with no problems including repeating the two missed doses. The Quadruple therapy 100% compliance on empty stomach.

Next steps:
Specialist has recommended treatment with a 14 day course of triple therapy including
Omeprazole 20mg twice daily, Amoxicillin 1g twice daily and Rifabutin 150mg twice daily.


Naturopathic
Started with naturopath to see if this could aid helping eradicate when next course of antibiotics is taken. Have been taking the following since:
Herbal Formula of Coptis Chinensis, licorice, turmeric, ginger.

From starting the naturopath formula within 2 days her burping has stopped.

Just started taking blended Broccoli Sprouts in water also.


Could you please share opinion on following:

Antibiotics taken in past could this be impacting the success of eradication? Had a lengthy course of antibiotic Minocycline for inflammatory acne in 2002 and Macrolide antibiotic approx. 15 years ago could this impact the antibiotic treatment?

How many times should the eradication treatment with antibiotics be taken?

If antibiotics don’t eradicate what other option is there?

The H.Pylori did not show up in samples taken in the last endoscopy and they took 8 samples so how does this still test positive in the stools?

Is it wise to take Amoxicillin for a third time?

If it is resistant to Amoxicillin does that mean it would have become resistant to the other antibiotics that have been tried in the triple and quadruple therapy?

Are drug treatments in Australia available that are not in NZ?

Many thanks for your time.

[Helico_expert]

endoscopy is usually the gold standard.
it's more likely for the stool antigen test to be false.

Nevertheless, you can wait a couple of months and then try breath test and see if you have H. pylori still.

Antibiotics taken in past could this be impacting the success of eradication? Had a lengthy course of antibiotic Minocycline for inflammatory acne in 2002 and Macrolide antibiotic approx. 15 years ago could this impact the antibiotic treatment?

No for minocycline but Yes, especially macrolide. H. pylori will learn how to become resistant to macrolides.

How many times should the eradication treatment with antibiotics be taken?

until it's confirmed eradicated.

If antibiotics don’t eradicate what other option is there?

There are no option options other than antibiotics. Antibiotics are proven the only way to get rid of H. pylori effectively.

The H.Pylori did not show up in samples taken in the last endoscopy and they took 8 samples so how does this still test positive in the stools?

Assuming the pathologist is professional. It's rare for endoscopy to be wrong. Usually endoscopy is more accurate because you can judge if there is H. pylori based on the inflammation pattern.

Is it wise to take Amoxicillin for a third time?

Yes, you can keep taking amoxicillin as H. pylori almost never become resistant to amoxicillin.

If it is resistant to Amoxicillin does that mean it would have become resistant to the other antibiotics that have been tried in the triple and quadruple therapy?

Amoxicillin is one the few that H. pylori is very hard to become resistant to. the other antibiotics that are hard to become resistant to include minocycline and bismuth and furazolidone. So these antibiotics can be recycled all the time. But they may come with strong side effect. please consult your doctor before trying.

Are drug treatments in Australia available that are not in NZ?

I am not too sure. But recently there is a new type of PPI, known as P-CABs (vonoprazan). you can check with your doctor about using it for your next treatment. It's much better than conventional PPI and can boost H. pylori cure rate.