4 treatments - Hpylori. Help!

[mellowell]

Hi.
I've had an unfortunate ride with h pylori.

I became symptomatic in June 2022, diagnosed in December 2022. I was treated, however my first 2 rounds failed. My third round however, managed to eradicate the bacteria.

By July 2023, i was completely asymptomatic and tested negative on endoscopy. I remained symptom free until September 2024, where a stool test showed me positive again. I took a fourth antibiotic, but then i subsequently tested positive on both UBT and stool test.

My past treatments are as follows:

st round January 23: Metronidazole 800mg, Omperazole 40mg, Amoxicillin 2000mg - 7 days
2nd round March 23: Clarithromycin 1000mg, Omeprazole 40mg, Amoxicillin 2000mg - 7 days
3rd Round April 23 : Clarithromycin 1000mg, Esomeprazole 80mg, Amoxicillin 2000mg - 14 days
4th round October 24: Tetracycline 2000mg, Lansoprazole 60mg, Amoxicillin 2000mg - 7 days

I asked about Rifabutin based triple therapy, however i havent found a doctor willing to prescribe it, as i must exhaust all other options first. Same applies for Furazolidone.

I would opt for antibiotic sensitivty testing, however im too broke to do it privately and through the national healthcare service, such a procedure would take months of wait as classifed non-urgent case.

However, i have been offered one of two following treatments:
1. Levofloxacin 500mg, Omeprazole 40mg, Amoxicillin 2000mg, Bismuth 525mg - 10 days
or
2. Metrodizanole 1000mg, Omperazole 40mg, Tetracycline 2000mg, Bismuth 525 - 10 days.

My question is:

1.which treatment should i go for? Option 2 seems to be the lesser effective due to my history of Metrodizanole use, but i am somewhat scared of the possible levofloxacin side effects. I dont have previous use of levofloxacin excluding ciprofloxacin for 7 days in 2020.

2. Is the PPI use sufficient if paired with the bismuth? Should i ask for more PPI or a second generation one?

3. is there any other combination (that isnt rifabutin and furziladone) that i havent tried that might be more effecctive than the two above?

Thankyou

[Helico_expert]

It is actually quite unusual for someone to get re-infected with H. pylori after they have completed treatment—this is a very rare event. If you have genuinely acquired a new infection, the most likely source is someone you live with, as the bacteria are typically spread through close household contact. Because of this, the smart approach is to have everyone in your household checked for H. pylori. If anyone else tests positive, it is strongly recommended that they receive treatment at the same time as you to prevent the infection from continually passing back and forth.

The treatment plan your doctor prescribed, involving a PPI, Bismuth, levofloxacin, and amoxicillin, is a very effective, modern combination. The key to ensuring the best chance of a cure lies with the PPI (Proton Pump Inhibitor). This drug’s job is to lower the amount of acid in your stomach severely. When the stomach environment is less acidic, the antibiotics can work much more effectively to kill the bacteria. Due to individual differences in how people metabolise drugs, some find that common PPIs like omeprazole do not suppress acid strongly enough. You might consider asking your doctor if a different PPI, such as rabeprazole (20mg twice daily), could be a better option for you. Similarly, you could inquire about increasing your amoxicillin dose to 1 gram, taken three times a day, as it is a highly effective component of the therapy.

It is important to be aware of a critical safety precaution while taking levofloxacin. This type of antibiotic can sometimes affect your tendons—the strong tissues connecting your muscles and bones. To avoid any issues, refrain from strenuous activities, such as heavy lifting or intense exercise, for the duration of the medication. Finally, to confirm that the entire treatment was successful and that the bacteria are gone, you must schedule a follow-up test. This check should always be performed at least one month after you have finished all of your medication.