2 treatment failures, what next ?

[AndyMac]

Suffer from Gerd, small hiatus hernia. Have H.pylori.

Had two or three treatments for this in the UK. The first time i was given a course of antibiotics with Lansaprozole, and felt better. Not sure what it was i was given. I then went to South East Asia, was eating street food, in relationship with different ladies, and my symptoms returned (not sure if related).

Developed very bad acid reflux. So this is when i really began to look into what was going on with me.

First treatment i had with a gastro doctor was Amoxcilillin and Metronidazole and Lansaprosole to be taken for 7 days. I got extra medication and took it for 11 days instead. Felt slightly better, but had a week back in Asia and symptoms were still there.

Second treatment was Amoxcillin and Levoflaxin and Lansaprozole to be taken for 7 days. Once again i took extra medication and went for 12 days. I stayed at home, but still have H.Pylori.

Each time i had a rough few weeks on the antibiotics (ie very tried, headaches). So to go through all that and still be left with this infection is DEVASTATING.

My questions are :

1) What should my next course of treatments be ? I have been treated in the past with Clarithomycin for other issues, but not sure if i was treated for this?

2) When should i give up?

3) Why are gastro doctors, and pretty much the whole profession in the UK still prescribing for only 7 days?

4) What is Bismuth? Why do none of the doctors mention this to me, or when i bring up just give a nod, but never prescribe it.

5) What is the issue of dangers of taking Clarithomycin - and the H.pylori mutating and becoming more resistant? Does this mean Clarithomycin should be avoided as it makes the H.pylori more stronger? Please explain the science behind this. Or is it simply a case that Clarithmoycin won't work.

6) The dangers of H.pylori. I really don't get it. If half the world has this infection, then why is it such an issue? How do i know it's not my Hiatus Hernia causing me discomfort and not the H.Pylori?

7) If you just keep taking different brands of antibiotics to find one that works, is this dangerous for the body, ie you may eradicate the H.pylori but you've left yourself exposed to other illness and non working antibiotics. etc

Please please any assistance would be welcome. In a world full of fear of this Corona Virus, i can't seem to get out of my own personal hell of H.Pylori.

[Helico_expert]

How do you know you still have H. pylori? did you do a breath test to confirm the infection?

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1) What should my next course of treatments be ? I have been treated in the past with Clarithomycin for other issues, but not sure if i was treated for this?

You should find a specialist who has access to a good laboratory that can do H. pylori culture and antibiotic sensitivity testing. That way, you get very high cure rate personalised treatment. If you cant, then perhaps your next treatment would be PBAT (PPI + Bismuth + Tetracycline + Metronidazole)

2) When should i give up?
When you decided that it's ok to have gastric cancer and it's ok to give the antibiotic resistant H. pylori to your children.

3) Why are gastro doctors, and pretty much the whole profession in the UK still prescribing for only 7 days?
On one hand, the doctors are under pressure not to give too much antibiotics. On the other hand, you need antibiotics.
Some doctors believes that if it is resistant, it doesnt matter how many days of antibiotics you are given.
7 days treatment will probably give you "ok" cure rate
10 days - good cure rate
14 days - High cure rate
We always give 10 days treatment.
your doctors probably know the cure rate of the 7 days treatment better than us.

4) What is Bismuth? Why do none of the doctors mention this to me, or when i bring up just give a nod, but never prescribe it.
Bismuth is a heavy metal compound. Very good in killing H. pylori. It was banned for a while in Europe because of its side effect. People who takes Bismuth will have very dark color stool, which confused doctor for internal bleeding. In early days, doctors are unaware of it and sent people for unnecessary operation.
Nevertheless, due to antibiotic resistance in H. pylori getting worse, Bismuth is now available in Europe. Perhaps some doctors are still haunt from it and reluctant to prescribe it.

5) What is the issue of dangers of taking Clarithomycin - and the H.pylori mutating and becoming more resistant? Does this mean Clarithomycin should be avoided as it makes the H.pylori more stronger? Please explain the science behind this. Or is it simply a case that Clarithmoycin won't work.
Clarithromycin is one of the best antibiotics. The side effect is low and it has fantastic cure rate. Because of that, it has always been the first line treatment for H. pylori. and because of that, people who doesnt remember what treatment that had before, doctors are just going to assume they had Clarithromycin before. H. pylori can become resistant to Clarithromycin if the patient had previous exposure to it.

6) The dangers of H.pylori. I really don't get it. If half the world has this infection, then why is it such an issue? How do i know it's not my Hiatus Hernia causing me discomfort and not the H.Pylori?
H. pylori is such a chronic infection. It will take decades for the symptoms to show up. There are many studies that show correlation of H. pylori and stomach cancer. It is also true that many people may carry it and die with it without knowing. However, as medical advancement, people is living longer and longer.
The longer you have H. pylori in you, the more damage it is going to cause. These damage builds up and is usually irreversible. So as your cancer risk builds up every year. When you eradicate H. pylori at the age of 50, your cancer risk then stays there. Your cancer risk is not going to be higher than those over 60 yrs old, but is not going to be lower than those below 50 who has no H. pylori. So we recommend eradication of H. pylori even if you dont have any symptoms.

7) If you just keep taking different brands of antibiotics to find one that works, is this dangerous for the body, ie you may eradicate the H.pylori but you've left yourself exposed to other illness and non working antibiotics. etc
There is like 7 common antibiotic classes that you can use. nothing to do with brands. for example, penicillin and amoxicillin are the same class. resistant to one will resistant to the whole class.
ciprofloxacin, levofloxacin, moxifloxacin, etc are all the same class.
Clarithromycin, Azithromycin, etc = same class
metronidazole, tinidazole, etc = same class

[AndyMac]

Thankyou so much for your replies.

I did have a culture done, but i believe there was no results from it. I was told before it was difficult to culture H.pylori. Is that true?

So far i have had Amoxcilillin , Metronidazole and Lansaprosole AND THEN Amoxcillin and Levoflaxin and Lansaprozole.

Any recommendations for another line treatment?

Where do i get Bismuth in the UK?

Thanks again for your answers.

[Helico_expert]

You should be able to get bismuth in UK.
There are many bismuth compound available.
If you search up pepto bismol, that's a very popular brand in US.

It is true that H. pylori is difficult to culture.

perhaps your next treatment would be PBAT (PPI + Bismuth + Tetracycline + Metronidazole)
You can ask your doctor about this regiment.

[AndyMac]

Do you think i should go for another endoscopy and try to get another culture done?

My consultant was pricking away taking samples, so i'm gutted he didn't pick up any culture. Why is it difficult to get a culture on the H.pylori?

I will give my consultant a go with your recomendation?

BTW as i've not used Clarithomycin for this regime, should i try that?

Also what is Pylera? Is it everything in one tablet?

[Helico_expert]

If you just had H. pylori, then i wouldnt recommend for another one this soon too.

Culture is hard for various reason. Some doctors like to take biopsy from abnormal site. Actually H. pylori likes to live in normal site. So you get less chance of getting H. pylori from abnormal site.

Then is the technician that is processing the biopsy. In low prevalence country like AU and UK, the technician are less experienced and so the success rate is lower.

As for Clarithromycin, if you had not tried before, then you should try that.

Pylera is what I recommended to you previously.
PPI + bismuth + Tetracycline + metronidazole
It's a lot more expensive to buy Pylera (brand). It will be much cheaper if you buy the drugs separately.

[AndyMac]

Again, thankyou for your reply.

1) What would go with Clarithomycin? (I've had Amoxcilillin , Metronidazole and Lansaprosole AND THEN Amoxcillin and Levoflaxin and Lansaprozole)

[Helico_expert]

you can try the following
Rabeprazole 20mg TID
Amoxicillin 1g TID
Clarithromycin 500mg BID

the above is an improved triple therapy.
you can also add bismuth to boost the cure rate.

[Atrix]

4) What is Bismuth? Why do none of the doctors mention this to me, or when i bring up just give a nod, but never prescribe it.
Bismuth is a heavy metal compound. Very good in killing H. pylori. It was banned for a while in Europe because of its side effect. People who takes Bismuth will have very dark color stool, which confused doctor for internal bleeding. In early days, doctors are unaware of it and sent people for unnecessary operation.

I beg pardon, if I am not right.. But to my knowledge bismuth was banned in Europe because of some people taking it in high doses and / or having kidney disorders developed encephalopathy due to this drug getting into central nervous system.. So, it is essential to not overdose and avoid taking it in case of renal problems..

[Helico_expert]

I beg pardon, if I am not right.. But to my knowledge bismuth was banned in Europe because of some people taking it in high doses and / or having kidney disorders developed encephalopathy due to this drug getting into central nervous system.. So, it is essential to not overdose and avoid taking it in case of renal problems..

you are probably right. But you'll have to take very large quantity to get the toxic effect. Bismuth is not readily absorb into human body. In fact, it's so safe, you can buy it from stores in US without prescription. People used to drink it like tea to stop the ulcer pain.