H. Pylori PPI + Antibiotics Therapy - Dosing Questions

[mjfuter]

Hi All,

What's the optimum way to dose the following PPI + antibiotics combination for H. Pylori eradication?

* Omeprazole
* Rifabutin
* Amoxicillin
* Levofloxacin

Also, what's the maximum dosage of bismuth chewable tablets I can consume per day to boost my treatment?

I'm working with a new GI specialist and this is the next round of treatment he wishes to prescribe for me.

Thanks!

[Helico_expert]

Most importantly is to have the medications spread as evenly as possible.
This is to make ensure that the concentration of the medication in your blood is consistently high and hard for H. pylori to withstand.
So if you are to take it twice a day, then every 12 hrs; three times a day, then every 8 hours; four times a day, then every 6 hours.

We normally prescribe bismuth up to 220mg 4 times a day.

[mjfuter]

I appreciate your quick response!

What do you think about the following dosages for my new 14-day treatment plan?

* 40 mg Omeprazole TID (every 8 hours)
* 50 mg Rifabutin TID (every 8 hours)
* 1,000 mg Amoxicillin TID (every 8 hours)
* 500 mg Levofloxacin BID (every 12 hours)

Thanks!

[Helico_expert]

Rifabutin dose is a bit low. you sure it's 50mg TID?

We normally prescribe 150mg BID.

[mjfuter]

Unfortunately, yes. It's 50 mg Rifabutin TID since my new GI specialist insists on using brand name Talicia in conjunction with Levofloxacin for this round of treatment. Here are the specs for Talicia:

http://www.talicia.com

In the United States, Rifabutin can only be ordered from a pharmacy in 150 mg capsule form. This means your suggestion of 150 mg Rifabutin BID is definitely an option.

I really appreciate you sharing your thoughts with me! I often struggle to get answers to my questions concerning H. Pylori here in the Dallas-Ft. Worth area of the United States.

[Helico_expert]

each Talicia tablet contain 12.5 mg of Rifabutin.
Patients are meant to take 4 Talicia tablets every 8 hrs.

12.5mg x 4 tablets x 4 times a day = 200mg per day.

still higher than your 50mg TID.

https://www.accessdata.fda.gov/drugsatf ... 004lbl.pdf

Perhaps you can consider increase your omeprazole dose as well.

[mjfuter]

According to the package labeling, each 14-day round of Talicia contains 2 bottles x 84 capsules = 168 capsules total.

https://www.talicia.com/

This means I'll take 168 capsules / 14 days = 12 capsules / day. When taking 4 capsules per dose, I get:

* 40 mg Omeprazole
* 50 mg Rifabutin
* 1,000 mg Amoxicillin

I interpreted "every 8 hours" as 3x per day instead of 4x, so my total daily intake is:

* 120 mg Omeprazole
* 150 mg Rifabutin
* 3,000 mg Amoxicillin

How high, in units of mg, do you recommend I go on the 3x daily doses of Omeprazole?

Thanks!

[Helico_expert]

gosh.. I think you are right. my mistake. Should be 3 times a day. not 4.

So it is 150mg for Talicia. Stick to it then.

[mjfuter]

What dosage for Omeprazole, greater than 40 mg, do you recommend I take 3x daily in conjunction with the antibiotics to aid in H. Pylori eradication?

Thanks!

[Helico_expert]

we normally prescribe rabeprazole 20mg TID, which is probably equal to 40mg omeprazole TID.