Helicobacter pylori, second time treatment

[Alme]

Hello all
I am 29 years old male. Last year I had huge heartburn therefor I did an endoscopy+biopsy which found gastritis and H. pylori. I started the treatment for H. pylori using Amoxicillin/omeprazole/clarithromycin. I had to stop it after 3 days due to huge diarrhea of over 9 times per day. Few months after I did another endoscopy and in addition to H. pylori and gastritis I have duodenitis. Right now I am under omeprazole for one month and I will start the H. pylori treatment again next week. This time the cure that my doctor gave me is: Amoxicillin/metronidazole/omeprazole/clarithromycin twice daily for 1 week.
I found this cure to be a little too much so I asked another gastro. He said I should try Amoxicillin/omeprazole/clarithromycin + probiotics.
What do you guys think? What if helicobacter has created some resistance towards Amoxicillin/omeprazole/clarithromycin combination? I really do not whom to trust. I just dont want to fail another time.
Thank you

[Helico_expert]

the only way to know if the drug will work is to do an endoscopy, get the biopsy and culture the bacteria, and do an antibiotic sensitivity test. That way, the doctor can prescribe the right antibiotics. However, such procedure is expensive and hence not generally practiced. Do you know if you are sensitive to amoxicillin? maybe you can ask your doctor to do a blood test and check for amox. allergy.

amox is a very potent antibiotic against H. pylori. We hardly ever see any Amox resistant H. pylori. Clarithromycin and metronidazole on the other hand, have high resistant rate among H. pylori. So I wouldnt repeat any of the above if it has been used before.

if you are interested in the resistance and our treatment for patients who had resistant strains, you can read our recent publication

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

[Alme]

Hello

Thank you for your reply.

I asked my doctor if It was possible to do the antibiotic sensitivity test but she refused to do so. As mentioned above I have tried amox for 3 days and I did not get any allergies from it, so I guess I am fine. The only problem is that I have to start the treatment this Monday but I have two different approaches from two different gastro:

1. Amoxicillin/omeprazole/clarithromycin + Probiotic (This is what I also tried 8 months ago but stoped after 3 days due to huge diarrhea)
2. Amoxicillin/metronidazole/omeprazole/clarithromycin

Shall I go for option 1 or 2?

[Helico_expert]

without knowing the resistance of the bacteria, I guess 1 or 2 is fine. Hopefully there will be less side effect this time.

[Alme]

Hello and thank you for your answers.
I decided to go for option number 1. I started with it yesterday. Right now I'm taking:
Amoxicillin 1000 mg + Omeprazole 20 mg + Clarithromycin 500 mg + Probiotic (saccharomyces boulardii) 250 mg.

Everything is taken twice daily for a duration of 7 days ( except omeprazole and probiotics which I intent to continue for one more week )

Just like the first time, the main issue I am having is diarrhea 4 times so far within a day.
I just hope mine is not antibiotic immune so I can get rid of it this time.
The second concern that I have is Clostridium difficile... I know there is a connection between antibiotic usage and c.diff. I just hope I will be safe. Also do you think I should increase the dosage of Probiotics to 3-4 per day? I am also eating yogurt as a natural probiotic. Any suggestions?

[Helico_expert]

There is always risk for c. difficile when you are taking antibiotics. However, we have treated thousands of patients and not seen one case. In addition, we gave more antibiotics and higher dosage. So I think your risk is pretty low (not that you dont have the risk).

[Alme]

Dear friends
I was able to finish the one week treatment without big side effects. The max bwm was 5 times which happened only one day, the rest of the days was between 2-3 which in my case are normal. I believe the secret was Probiotic (saccharomyces boulardii) 250 mg twice daily + AB yogurt. Actually I strongly believe the AB yogurt played a big role in limiting my diarrhea. I had 5 times bm the first day and as soon as I started to take the yogurt everything was back to normal. I strongly encourage those of you who are going for this treatment to consider AB yogurt, since it's full with the good bacteria which unfortunately will be killed by antibiotics. I just have to wait for 4 weeks in order to check out if the treatment was successful. Will keep you posted as soon as I find out.

All the best