Positive test results, triple therapy for 7 days...worried it won't work and going 2 months to South America

The most popular treatments consist of two antibiotics (one of which is usually clarithromycin) plus a strong acid blocker such as omeprazole (PriLosec, Nexium, Somac, Zoton, etc.). Treatment is for 7-10 days. Cure rate is about 85%

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canadianhelico
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Joined: Fri Jun 22, 2018 12:49 am

Positive test results, triple therapy for 7 days...worried it won't work and going 2 months to South America

Post by canadianhelico » Fri Jun 22, 2018 6:16 am

Hello there,

Me: male, 35 years old living in Canada.

I don't know where I could have gotten infected, maybe when I swallowed water in the ocean by accident in Mexico last summer, or because my now ex-wife is Colombian and Colombia has one of the highest rates in the world, but after eating out for a week because of work, with a lot of IBS symptoms and constipation (not really any H-pilory symptoms except maybe gastric reflux after eating). I went to see my doctor. I never really had any constipation or stomach problems before this episode when on the road. I ate lots of bread, beer, drank lots of coffee and almost no water. My gut flora must have been all messed up.

She said at first she thinks it's IBS because all cultures of parasites in stools etc were all clean. My symptoms were also getting better with the days going by, managing my stress and trying to eat healthy. I still insisted to get tested for h pilory. My doctor asked me to do a blood test. It came back positive. She wanted me to start treatment right away but I asked for a breath test before. It also came back positive.

Now, she prescribed me the traditional 7 days triple therapy (HP PAC by mylan): lansoprazole delayed-release capsule 30g + clarithromycin 500mg + 2x amoxicillin 500mg. I need to take that cocktail in the morning before breakfast with water all at once and the same thing at dinner. I started taking the antibiotics today, this morning. I also am taking probiotics capsule once per day at lunch time. It's probaclac 6.5 guaranteed billion active cells from 7 different strains. Now, i read on the internet that the 7 day triple therapy is an old school treatment that isn't really good anymore. So, I'm kind of bumped and annoyed she prescribed me this, and only for 7 days.

The problem is that I have a trip of 2 months coming up. I am leaving on July 15th. I won't be able to do another breath test to be sure it's eradicated before coming back from South America (Argentina, Uruguay, Brazil). It's kind of stressing me out because I want to be able to have fun there, and not be thinking about stomach issues or being afraid to catch the bacteria again. I'm an anxious person, and it can occupy my mind all day.

I have a few questions:

1. Should I try to reach out to my doctor and ask her to add 7 days, so it would be a 14 day process. Do I have higher chance of having success with this? I can't really add another antibiotics right now?
2. Is there anything else I could add that is buyable without a prescription to help me?
3. The probiotics I take doesn't contain the strain Saccharomyces boulardii, should I get some. I read somewhere that it helps treating H. Pylori. Is it true?

Thank you very much. I am kinda lost here.

UPDATE 1:
I talked to my pharmacist and he told me he will call the doctor to make her accept this formula:

bismuth 2 caplets
métronidazole 500mg
tétracycline 500mg
IPP

is this a good formula?

Helico_expert
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Re: Positive test results, triple therapy for 7 days...worried it won't work and going 2 months to South America

Post by Helico_expert » Fri Jun 22, 2018 9:01 am

Most people caught H. pylori when they are young. Usually from infected mother who share food with her children. of course, it's possible to catch it from your wife too. Perhaps you should ask your wife to get a check up and have the treatment together.

in regards to your 7 days treatment, I assume your doctor understand the local strains well and knows what is the best treatment. If your strain is not resistant to the antibiotics, 7 days is normally enough. If it is resistant, it wont work with 14 days.

I think you should just follow her instruction and finish up this course. Then enjoy your trip in July and do the breath test later.

If you have reflux symptom, you can buy PPI or H2 blocker without prescription to help with the acid reflux. That will protect your throat and teeth.

To date, no Probiotics have been proven able to kill H. pylori in vivo. But, it may be helpful with the side effect and prevent bad bacteria overgrow after antibiotic treatment. Since it's harmless, you can always try tsome.
UPDATE 1:
I talked to my pharmacist and he told me he will call the doctor to make her accept this formula:

bismuth 2 caplets
métronidazole 500mg
tétracycline 500mg
IPP

is this a good formula?
Ya, it's a good formula. But we normally use it when the first triple therapy fails. However, you can buy the bismuth to add to your current standard triple therapy to boost the cure rate.

canadianhelico
Posts: 18
Joined: Fri Jun 22, 2018 12:49 am

Re: Positive test results, triple therapy for 7 days...worried it won't work and going 2 months to South America

Post by canadianhelico » Fri Jun 22, 2018 10:06 am

thank you for your answer.

If you had to choose between CLAMET Quad for 14 days and BMT Quad for 14 days, is there one that is more effective than the other vs possible side effects?

In Canada, the Toronto consensus favorises this over what my doctor prescribed me: https://www.cag-acg.org/images/publicat ... s_2016.pdf

To be honest, my doctor didn't even know about UBT, so I doubt her skills when it comes to treatment. She's just a general practitioner because I can't have access to a direct specialist (6 months or more waiting time), that's how the system works here. The pharmacist told me that the HP Pack was prescribed about 10 years ago, it's not so anymore.

Also, since I don't know where I got it from, it might be in Colombia, Mexico or all over since I've travelled a lot or in could have been when I was younger, I think I would prefer the best "formula" with the most chance of eradication.

Thank you

Helico_expert
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Re: Positive test results, triple therapy for 7 days...worried it won't work and going 2 months to South America

Post by Helico_expert » Fri Jun 22, 2018 11:01 am

Clarithromycin and Metronidazole are more of a first line basic and common antibiotics. They have good cure rate if you dont normally take antibiotics in your life.

H. pylori can never develop resistance to Amoxicillin and Bismuth. So you can always repeat these antibiotics. Amoxicillin is preferred because it is very safe and you can take in high dose. Bismuth is preferred because it can prevent C. diff complication during antibiotic treatment.

Recent study also suggest that high dose PPI can boost cure rate.

So, in summary, we normally give high dose PPI and bismuth.
if you are not allergic to amoxicillin, you can ask for high dose amoxicillin
then one more antibiotic, either Clarithromycin or metronidazole, if you had not taken them before.

if this treatment fail, then you can try the second line treatment, which is stronger, and more side effect. such as ciprofloxacin or tetracycline.

canadianhelico
Posts: 18
Joined: Fri Jun 22, 2018 12:49 am

Re: Positive test results, triple therapy for 7 days...worried it won't work and going 2 months to South America

Post by canadianhelico » Fri Jun 22, 2018 7:18 pm

Ok,

I will just ask for the Bismuth + amo + metra + double dose PPI....I'll take this for 14 days. The only thing that worries me is that bismuth gives constipation and that's the main problem I had when all this started. Also, side effects suggest tinnitus. I already have tinnitus, I don't want to make it worse....

canadianhelico
Posts: 18
Joined: Fri Jun 22, 2018 12:49 am

Re: Positive test results, triple therapy for 7 days...worried it won't work and going 2 months to South America

Post by canadianhelico » Sat Jun 23, 2018 12:03 am

so, I went to see my doctor and she messed up again:

she prescribed

bismuth : 2xcaps 4 times per day
IPP: 2 times per day
Met: 500mg 2 times per day
Tetracycline: 500mg 4 times per day

Will this give good results too? I'm afraid the MET is on the low side with a lot of resistance already...

Helico_expert
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Re: Positive test results, triple therapy for 7 days...worried it won't work and going 2 months to South America

Post by Helico_expert » Sat Jun 23, 2018 12:16 am

we call this the PBMT treatment. Metronidazole and Tetracycline has good synergistic effect and has good cure rate. You can imagine that Metronidazole is the toxin building up in the bacteria. The resistant strain is able to neutralize the toxin quickly. Tetracycline on the other hand is stopping the bacteria from making the neutralizer. So the toxin can build up and kill the bacteria.

canadianhelico
Posts: 18
Joined: Fri Jun 22, 2018 12:49 am

Re: Positive test results, triple therapy for 7 days...worried it won't work and going 2 months to South America

Post by canadianhelico » Sat Jun 23, 2018 12:39 am

Helico_expert wrote:
Sat Jun 23, 2018 12:16 am
we call this the PBMT treatment. Metronidazole and Tetracycline has good synergistic effect and has good cure rate. You can imagine that Metronidazole is the toxin building up in the bacteria. The resistant strain is able to neutralize the toxin quickly. Tetracycline on the other hand is stopping the bacteria from making the neutralizer. So the toxin can build up and kill the bacteria.
Ok, it's just that 2 times per day of flagyl vs 4 times recommended by the toronto concensus, will this have an impact on the possible cure?

canadianhelico
Posts: 18
Joined: Fri Jun 22, 2018 12:49 am

Re: Positive test results, triple therapy for 7 days...worried it won't work and going 2 months to South America

Post by canadianhelico » Sat Jun 23, 2018 7:38 am

Finally, I decided to do the 7 day triple therapy. I will add bismuth to it. I will test again when I come back. There is a good chance I might catch it again in brazil, and since it's a tough drug regimen (the quadruple), might just wait until I come back if this treatment didn't work. I hope I don't get ugly symptoms there....what do you think I could use there to help me for constipation and stuff

Can I keep the tetracycline safely at home for 3 months or it will expire?? I heard it's bad when you take it after the expiry date.

Helico_expert
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Re: Positive test results, triple therapy for 7 days...worried it won't work and going 2 months to South America

Post by Helico_expert » Sat Jun 23, 2018 7:53 am

If you have good hygiene, eg. brush teeth, wash hands, not sharing food and drinks, after H. pylori is eradicated, I dont think you'll catch it again.

Have fun in Brazil. be positive!

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