Helicobacter Forums

Ever since I was diagnosed with H. Pylori, my GP and my Gastroenterologist have been giving me all these strong antibiotic therapies one after another. After a positive UBT, my GP prescribed me the standard Triple therapy (Nexium HP7). After 4 weeks another UBT shows still positive for H. Pylori. So, I was referred to a gastroenterologist who prescribed me the Quadraple therapy straight away(Clarythromycin/Doxycillin/Rifabutin/Pantoprazole)!

After finishing the Quadraple therapy, my gastroenterologist did an endoscopy. He took biopsy sample for histology. He also did a rapid Ureas test only to find out that I'm still positive. Three weeks later histology report shows "Sever Helicobacter gastritis with intestinal metaplasia". Surprisingly, he did not take any sample to culture the bacteria! Now he has prescribed me the Salvage therapy (Levofloxacin 1gm/Amoxycilling 2gms/Pantoprazole 80mg daily). So, I'm on my third course of therapy not knowing if this will actually work(?)

I've told you my treatment history because, to me, it just doesn't seem right the way my treatment is going. After the failure of the first treatment, they should have done a culture of the bacteria to find out the strain and then they should have prescribed me an effective antibiotic course.

So, my question is why doctors do not get a culture done to find the strain of the bacteria before prescribing those strong antibiotic courses, instead of throwing stones in the dark? Why do we not have a standard protocol of culturing the bacteria after the failure of the first treatment?

Antibiotics such as Rifabutin, Levovloxacin etc, as I understand, are trial medicine and we don't know yet what long term side effect(s) they will have on us. Somewhere in the forum I read that these antibiotics can cause diverticulitis in the long term. I understand the importance of eradicating H. Pylori but does it worth taking a shot in the dark?

it's all about cost effectiveness. in normal situation, the standard triple therapy will have a cure rate of 80%. Then the following quadruple therapy would have a cure rate of 90%. So it is unfortunate that you are one of those 10% among the 20% who failed the two treatments. Then, a bacterial culture is normally recommended. However, if your doctor is confident enough or have no access to bacterial culture service, then he'll prescribe you another set of quadruple therapy.

I would like to stress that H. pylori is not easy to culture. We are expert in culturing H. pylori and we only have a success rate of 90%. Compare to commercial laboratory, they only have a success rate of 50%. In some developing countries, due to lack of experience and proper equipment, their culture success rate is merely 30%.

Rifabutin and Levofloxacin are on the market for a long time. However, they are regulated drugs and should be reserved for special cases. This is to prevent other bacteria to become resistant to these special antibiotics. It is true that overuse of antibiotics, not just these two, can give you antibiotic related diarrhea. However, i am not sure if antibiotics can cause long term diverticulitis. do you have a reference that you can share?

Thank you very much for your reply.

About diverticulitis, I was referring to your answer to the topic "Problems after treatment" by Angeleo. I assumed that taking all these antibiotics will cause an imbalance in the microflora and eventually lead to diverticulitis.

It is a bit disappointing to know that the success rate of culturing the bacteria is not as good enywhere else as it is at your lab. Just curious to know, is it because your lab has better technology?

10% of the 20% of the 50% of the world's population is quite significant (about 70 mil given world's population is 7 bil). I wish we could be more compassionate than cost-effective. We have an antibiotic resistance awareness campaign going on in Australia yet we cannot afford to do culture to avoid unnecessary antibiotic.

I was wondering if your lab takes samples from patients. If yes, I'd love to have mine cultured at your lab. Please let me know.

I really appreciate your response.

Unfortunately we do not accept samples from general public. However, if you can get your test done else where in Australia, you maybe able to get Prof. Marshall to review your medical report and give recommendation.

Thank you again, helico_expert.

I have had an endoscopy done on 27 August 2015. But the problem is, my gastroenterologist did not do a strain culture. A histology was done on biopsy sample that shows "severe helocobacter gastritis with intestinal metaplasia". Do you think Prof Marshall can make me a prescription based on this report and a history of previous failed treatments?

"Culture, requiring an endoscopy, has excellent specificity and is necessary for determination of antibiotic sensitivities. However, culture is difficult to perform, so negative cultures may be falsely reassuring. Several studies have shown that higher eradication rates are obtained when antibiotics are chosen based on susceptibility testing rather than chosen empirically, and this may also be a cost effective approach.20 Strong evidence of infection certainly raises the motivation of the patient and the physician, therefore improving cure rate."

docs/200808%20stenstrom%20Hp%20Treatment.pdf

I have PM you the secretary's contact.

Much appreciated. I've sent all the papers.

Regards