Please advice on treatment

[rk32]

hi, I am m/38.
I had lot of burning sensation and discomfort in abdominal region. I took many antacids which were totally ineffective. Finally I got my endoscopy & biopsy done and h pyroli was given as a plausible reason. I took twice for 7 days: a) Clatithromycin 250mg b) Tinidazole 500mg c) Lansoprazole 30 mg.
I was absolutely fine after taking my course but after 3 month again the symptoms have returned, not as severe but still discomforting. I have starting taking curd which is definitely helping.
My specialists had suggested that I should take another course of antibiotics. There are three options of medicines prescribed by three different doctors (two specialist and one outstation old family doctor):
1. a) Clatithromycin 250mg b) Tinidazole 500mg c) Lansoprazole 30 mg for ten days
2. a) Amoxycillin 750mg b) Tinidazole 500mg c) Omeprazole 20 mg
3. a) Clatithromycin 250mg b) Amoxycillin 500mg c)Tinidazole 500mg d) Lansoprazole 30 mg
I am in slightly remote location so second endoscopy is not possible right now. PLEASE advice me from the above options which one do you think will be the best course or what will you suggest? Since after the first course I was absolutely fine, does it mean I have contracted disease again or what?
I don’t smoke or take alcohoI. I am taking medicine for BP and have no overweight issue.
I will very grateful for your suggestions.
kind regards

[Helico_expert]

i think you should do a follow up breath test to confirm that you still have the bug before taking any antibiotics.

if you really have to take antibiotics, and the list is really the only choice you have, i'll pick 2. (Amox, Tinidazole, and PPI). Reason is because clarithromycin is very easy to be resistant to. in our clinic, which we only look at resistant cases, the clarithromycin resistance rate is now 95%. meaning, almost all patient who failed the conventional therapy is due to the resistance to Clari.

if you have other choice, i would suggest not to go ahead with tinidazole too. ask the doctor what other choices you have. have a look at our publication on the choices we give to resistance patients.
PS: tinidazole is also known as metronidazole in our article.

original article
http://onlinelibrary.wiley.com/doi/10.1 ... 49C.d01t01

supportive document with the different antibiotic combinations
http://onlinelibrary.wiley.com/store/10 ... 4ca1d1eb37

[rk32]

thanks for a very helpful and quick response.
Can you please tell me
a) what is the difference between HELICOBACTER PYLORI, IgA test & HELICOBACTER PYLORI, IgG test?
b) Whether they are any good to find infection or not?

thank you once again

[Helico_expert]

IgA and IgG are both antibodies against H. pylori. When you are infected with a pathogen, your body will create a lot of these IgA, IgM, or IgG to fight off the infection. These Ig are very very specific to the pathogen. For example, a H. pylori IgG will not cross react with an E. coli. So, it is possible for us to try detect the presence of these Ig in your blood. If presence of IgA or IgG against H. pylori, then you are infected. The volume of their presence is not important.

the accuracy of using blood test (detection of IgA or IgM) is very good. but you cannot use it to check if you are currently infected. Once you are infected with H. pylori, your immune system will have memory of this infection. Your immune system will keep making these IgA or IgM for the next 3 years or more.

If you want to know if you are still infected with H. pylori, you'll have to either breath or stool test.

[rk32]

thanks.

After your valuable advice, I have started with my antibiotic course PARC (discussed with my doc)
1) Augmentin 1000 Duo (Amoxycillin Trihydrate/Potassium Clavulanate)
2) Rabeprazole 20mg tablet
and after fifth day I will start with
3) Rifabutin 150mg
4) Ciprofloxacin 500mg

I hope I have got the right combination from your link.
In place of Amoxycillin 1000mg only. I am taking Augmentin 1000 Duo. I hope it is right. Can you PLEASE kindly confirm.

THANKS.

[Helico_expert]

it should do the job. Do keep us updated with your treatment progress.

[rk32]

I am feeling better after 4 doses of antibiotic. Thank you for that.

I am very curious to know one thing and my doctor's answer was not very convincing. I hope you can help me
say one takes antibiotic course then

a) Antibiotic has not worked and the infection has relapsed or recurred (bacteria was not wiped out so regenerated)
or
b) Antibiotic has worked but after some time the person has been re-infected (contaminated food/water new bacteria enters body)

In scenario (b) antibiotic has worked but we will think it was not effective, so how do we know whether this is the case or not?

Is it possible that once the bacteria is wiped out it never occurs again as body has developed resistance to it?

I am asking this because, i live in the same place, so i eat-drink almost same set of things so if I can get infected once, it may happen again unless and until i identify the source; which is going to be difficult task. I can't blame it on the set of antibiotics. ( i drink bottled water and only consume home cooked food still it happened)

I hope my questions are clear. Please answer them.
I am grateful for all your help and concern.
THANKS

[Helico_expert]

H. pylori infection is very interesting because most people caught it during child-hood and remain asymptomatic. A Japanese group found that children as young as 2 years old is already infected by H. pylori. Usually infected by the closest carer, the mother.

It is less likely for adult to catch H. pylori because of the hygiene awareness. As long as you dont share the same food and drink, your chances of catching H. pylori is pretty low. Then again, we have evidence that showed couple carrying very similar H. pylori strain. Meaning it is possible for H. pylori to be transmitted between couple. Therefore, it is better to check everyone under one roof and get everyone treated to minimize the chances of reinfection.

if I did not answer your question, please ask again.

[rk32]

thank for the reply,

As I understand your answer it means that i may get infected from my wife if she is asymptomatic carrier. Antibiotics may heal me but I may get infected from her.

I think this problem can be tackled if she also undergoes antibiotics treatment but before that she should be tested for infection.

Please confirm if I have interpreted your answer correctly.

thanks

[Helico_expert]

You interpreted perfectly.