4 therapies failed, need advise

The cure of Hp usually requires antibiotics. Other things have been tried and have a weaker effect.

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chetanvenki
Posts: 19
Joined: Tue May 21, 2019 9:05 pm

4 therapies failed, need advise

Post by chetanvenki » Thu May 23, 2019 10:04 am

Hi Helico,

First of all thanks to the forum for this noble service.

I am 34 from India, Bangalore, I had burning sensation in all parts of my digestive system, diagnosed with H.pylori since 6 months with Endoscopy RUT positive and no ulcer or other abnormalities detected. I am not sure if this was right diagnostic, since I did not just had burning sensation in upper abdomen but also lower abdomen.

1st therapy - My GI first prescribed Sompraz HP
Amoxycillin (500mg) + Clarithromycin (500mg) + Esomeprazole (40mg) - daily twice for 14 days
UBT was positive after 1 month from stopping antibiotic therapy (some new kind of Helico Ammonia Test, not same as C 14/13, link https://www.news-medical.net/HELIC-Ammo ... r-from-AMA)

I had similar burning sensation all over the digestive system not just in the upper abdomen.

2nd therapy - Then same GI prescribed below

Amoxycillin (750mg) - twice daily for 14 days
Clarithromycin (500mg) - twice daily for first 7 days
Levofloxacin (500mg) - twice daily for next 7 days

UBT was positive again after 1 month from stopping antibiotic therapy.

My symptoms were back again after stopping PPI for 3 days.

3rd therapy - This time I consulted other Doctor and he did endoscopy RUT positive and histology showed mild gastritis and no other abnormalities, he prescribed below

Amoxycillin (1g) - twice daily for first 7 days
Clarithromycin (500mg) & Levofloxacin (500mg) - twice daily for next 7 days
Pantodac 40 - twice daily for 14 days

This time I was feeling all right without symptoms for almost a 2 months after stopping my antibiotic therapy, but from last 3 weeks again I started feeling burning sensation in mostly upper abdomen and sometimes lower abdomen, not severe compared to first two times. My stool test was negative but I was tested positive again with UBT after almost 10 weeks from 3rd therapy.

Now my GI was on long vacation, I consulted another senior GI in same hospital, he prescribed below

4th Therapy
Amoxycillin (1g) - twice daily for 28 days
Tetracycline (500mg) - twice daily for next 28 days
Providac (probiotic) - thrice daily for 28 days
Pantodac 40 - twice daily for 28 days

Now I have started with this 4th therapy, I dont have much side effects to worry except bad taste on tongue, fatigue sometimes. I have following questions

1. Is it safe to take antibiotics for 28 days, as my GI told its WHO guidelines to prescribe for 28 days after multiple therapy failures.

2. Is the 4th therapy prescription is correct ? considering Bismuth or Pylera is not available in India

3. Bacterial culture and antimicrobial susceptibility test not available in my city, can you please tell me where in India this is done. I heard in AIIMS Delhi and JIPMER in Pondicherry does research on this decease and they may do bacterial culture.

4. I cannot import Bismuth from US with foreign prescription, what is the best way to obtain Pylera into India.

5. My GI told not to get UBT test done again after therapy, unless the symptoms are back, is it safe to have H.pylori without symptoms ?

I really appreciate your help.

Thanks
Last edited by chetanvenki on Mon Aug 05, 2019 1:04 pm, edited 1 time in total.

Helico_expert
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Posts: 3503
Joined: Wed Mar 02, 2011 7:20 am

Re: 3 therapies failed, currently on 4th therapy for 28 days, need advise

Post by Helico_expert » Thu May 23, 2019 11:12 pm

I think if the strain is resistant to the antibiotics, it doesnt matter how many days you take it. If the treatment work, 10-14 days should be good enough.

Your 4th treatment is pretty strong. hopefully it will work.

I think you need to get breath test done, one month after treatment.

you can try contact trimed.com.au to get bismuth.

chetanvenki
Posts: 19
Joined: Tue May 21, 2019 9:05 pm

Re: 3 therapies failed, currently on 4th therapy for 28 days, need advise

Post by chetanvenki » Fri May 24, 2019 12:25 am

Thanks a lot for your reply

Is it better if I take Amoxicillin 1mg & Pantodac 40mg 3 times a day for 14 days ?

Do you know anywhere in India who does culture/susceptability test ?

Helico_expert
Site Admin
Posts: 3503
Joined: Wed Mar 02, 2011 7:20 am

Re: 3 therapies failed, currently on 4th therapy for 28 days, need advise

Post by Helico_expert » Fri May 24, 2019 8:39 am

Amoxicillin 1mg & Pantodac 40mg 3 times a day for 14 days is fine.

Sorry I cannot tell you who can culture H. pylori in India.

chetanvenki
Posts: 19
Joined: Tue May 21, 2019 9:05 pm

Re: 3 therapies failed, currently on 4th therapy for 28 days, need advise

Post by chetanvenki » Fri May 24, 2019 8:58 am

Helico_expert wrote:
Fri May 24, 2019 8:39 am
Amoxicillin 1mg & Pantodac 40mg 3 times a day for 14 days is fine.

Sorry I cannot tell you who can culture H. pylori in India.
Thanks a lot. I will update you after my UBT test.

chetanvenki
Posts: 19
Joined: Tue May 21, 2019 9:05 pm

Re: 3 therapies failed, currently on 4th therapy for 28 days, need advise

Post by chetanvenki » Wed Jul 17, 2019 8:45 am

Its 5 weeks since I completed by 4th round of ABX. Took PPI (pantodac 40mg) for one one month and gradually reducing the dosage on alternative days for another 2 weeks. I am planning to go for UBT in next month.

Can I switch now to Ranitidine on alternative days? if yes, what should be the dosage ?
What are the long term side effects of taking Ranitidine ? is it as safe as PPI ?

Helico_expert
Site Admin
Posts: 3503
Joined: Wed Mar 02, 2011 7:20 am

Re: 3 therapies failed, currently on 4th therapy for 28 days, need advise

Post by Helico_expert » Wed Jul 17, 2019 10:14 am

Ranitidine is very short life and safe. Many people take it for years.

In regard to dosage, you just experiment on yourself. Usually one table is enough. Ideally, you should take it 30 min before the symptoms appear, which is usually happened during meal time.

chetanvenki
Posts: 19
Joined: Tue May 21, 2019 9:05 pm

Re: 3 therapies failed, currently on 4th therapy for 28 days, need advise

Post by chetanvenki » Mon Aug 05, 2019 12:42 pm

My fourth UBT also came Positive.

But the result came as 39 CPM, but the cut off was 40 CPM (40-50 is grey area). My GI (different GI this time) told we need to treat it as positive.

I stopped PPI 2 weeks prior to test and ranitidine 1 week prior to test. is my UBT positive ? should I get another test ?

for my fourth round of therapy I took

4th Therapy
Amoxycillin (1g) - thrice daily for 14 days
Tetracycline (500mg) - twice daily for 14 days
Providac (probiotic) - thrice daily for 14 days
Pantodac 40 - twice daily for 14 days

Now GI advised me to remove my dental plaque and do Betadine (Povidone-iodine) gargle for 3 weeks and also check my ENT doctor for Sinus, as HP can live in both teeth plaque and sinus. Is it true ?

And then he prescribed below abx

metronidazole - 400 mg - twice in a day for 14 days
clarithromycin - 500 mg - twice in a day for 14 days
PPI 40 mg - twice in a day for 14 days
Bismuth - 262 mg - thrice a day for 30 days (pepto-bismol chewable tablet that I imported from Amazon.com, as it was not available in India)

what do you think of this treatment, as I had taken clarithromycin twice already in my 1st and 2nd therapy rounds. Should I swap it with Tetracycline 500mg twice a day ? or take as per Pylera dosage ? I had taken Tetracycline in my 4th round, but it didn't work.

Please suggest me right antibiotics and what dosage I need to take now for my 5th round of therapy.

I am trying to get HP culture and antimicrobial susceptibility in India, but not finding any lab doing these tests. Do you know any hospital doing these tests in Sri Lanka, which is near to my country time and cost wise.

Thanks in advance.

Chethan

Helico_expert
Site Admin
Posts: 3503
Joined: Wed Mar 02, 2011 7:20 am

Re: 4 therapies failed, need advise

Post by Helico_expert » Mon Aug 05, 2019 1:59 pm

I think it's important to confirm the infection before treatment. You got borderline result. what did your endoscopy show? have they done Rapid Urease Test? or Histology?

by the way... sometimes, it's not easy to culture from low breath test patient as well. Low breath test could indicate low bacteria load. high chance of culture failure.

chetanvenki
Posts: 19
Joined: Tue May 21, 2019 9:05 pm

Re: 4 therapies failed, need advise

Post by chetanvenki » Mon Aug 05, 2019 2:50 pm

I had done two endoscopy RUT before, both came positive. One immediately turned positive, second RUT turned positive just before 24 hours. Histology not done properly, it just showed I had mild gastritis, it did not talk about presence of pylori. But all three UBT's prior to this came positive comfortably, but it was a different method not C14 isotope UBT, see below

My UBT was ammonia based method, not typical C14 type. It just shows positive or negative without much quantifying, plz check below link
https://www.news-medical.net/HELIC-Ammo ... r-from-AMA

I still have all the symptoms. Should I wait for some more time and get UBT test again or I should go for endoscopy RUT & histology.

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