Need an expert advice on another treatment.

[Oneluckygirl]

Hi,
my first treatment has failed. I have repeated the same meds and dosages again, a month later (which now I know I shouldn't have done!)
Could a helico-expert advise please on another treatment course?

My first treatment was
WEEK ONE:
1. PPI 20mg x 2 times a day (morning/evening).
2. Amoxicillin 1gr x 2 times a day (morning/evening).
3. Bismuth 262mg x 2 pills x 2 times a day (morning/evening).

WEEK TWO:
1. PPI 20mg x 2 times a day (morning/evening).
2. Bismuth 262mg x 2pills x 2 times a day (morning/evening).
3. Metronidazole 500mg x 3 times a day (morning/lunch/evening)
4. Levofloxacin 250mg x 2 times a day (morning/evening).

[Helico_expert]

you are right that you should repeat the same drug.

H. pylori will never resistant to Amox and Bismuth, so you can keep on taking.

so discuss with your GP of switching levo and metro to something else like Tetracycline or rifabutin.

[Oneluckygirl]

Thank you so much for such a quick response!
Im in Turkey now and don't have a good GP. Still being looking though. I've seen 4 doctors and finally the last one has prescribed me the antibiotics.
Thats what I thought, that I should change something on my second week. Coz I feel so much better after Amox/ Bismuth week, and on the second week my abdominal pains return. I will ask in pharmacies if they have Rifabutin (Mycobutin) in here (antibiotics are available without a prescription in Turkey). What about Metronidazole on my second week, do I have to keep on it?

[Helico_expert]

"second week" - if you meant second trial, then you should change your metronidazole

if you meant the first trial, you already half way through the treatment, you should continue taking.

do discuss with your doctor before taking rifabutin and any other antibiotics. ask the doctor about the side effects. also, rifabutin is the primary drug for tuberculosis. it will not be easily accessible.

[Oneluckygirl]

"second week" I mean that the doctor has divided my 14 day course antibiotic treatment in two parts. Week one just PPI/Amox/Bismuth =7days. Next, second week PPI/Bismuth/Metronidazole/Levofloxacin = 7 days.
I have repeated the whole 14 days course twice. Exactly the same meds. And the doctor has told me to repeat this treatment many times.
I Do know that I should discuss medication, dosages and side effects with a doctor first of all. Want to see what the best real treatment options are before I go to see another insane doctor.

[Helico_expert]

so since you already tried metronidazole and levofloxacin, you should try other antibiotics combination.

Go seek for second opinion. if possible, arrange an endoscopy examination and get biopsy, and get bacteria culture for antibiotic sensitivity test.

[Oneluckygirl]

To get bacteria culture for antibiotic sensitivity test was my first thought after my treatment has failed. I hope I can find a doctor who could order this test for me. I have called and went to many clinics around and none of them have even simple helico breath test! Then, doctors here would never listen to what a patient thinks, no way to discuss. very frustrating.
Thank you very much for your advices!

[Helico_expert]

This is our recent published article for resistant strains.

original article
http://onlinelibrary.wiley.com/doi/10.1 ... 9/abstract

supporting document with treatment plan
http://onlinelibrary.wiley.com/doi/10.1 ... 9/suppinfo

hopefully it'll be useful to you or your doctor.

[Oneluckygirl]

I went through these studies before registering on the forum. Thank you!