Dr Azhar Manzoor asked 2 months ago
I was treated for H pylori infection in June with 3 medicines for 2 weeks in June.
I developed symptoms of indigestion again and have tested positive for H pylori infection again.
What should I do now?
Dr Abraham answered 1 month ago
Hello.
Since you were initially treated with a standard triple therapy regimen (Amoxicillin, Clarithromycin, and Omeprazole) and symptoms have returned with a positive H. pylori stool antigen test, it is likely that the bacteria have either not been eradicated or have developed resistance to Clarithromycin.
The recommended next step would be to switch to quadruple therapy, which is highly effective in cases of resistance or treatment failure. This typically includes:
• A proton pump inhibitor (PPI) (e.g., Omeprazole or another PPI twice daily)
• Bismuth subsalicylate (240 mg four times daily)
• Tetracycline (500 mg four times daily)
• Metronidazole (500 mg three to four times daily)
This treatment is usually administered for 14 days.
Alternatively, if bismuth quadruple therapy is unavailable or contraindicated, a levofloxacin-based triple therapy could be considered, which includes:
• A PPI
• Amoxicillin
• Levofloxacin
After completing the treatment, it is crucial to confirm eradication of H. pylori. The stool antigen test or the urea breath test should be repeated at least 4 weeks after completing the antibiotic course and ensuring that PPIs are stopped for 1-2 weeks before the test for accurate results.
It’s also essential to review potential sources of reinfection and discuss dietary and lifestyle modifications to support treatment success.
Which medicines (antibiotics) you have used and for how long?According to recent guidelines 2 weeks triple therapy or incase of resistance quadruple therapy should be taken and UBT (urea breath test) or stool antigen test should be repeated minimum 4 weeks after treatment ideally it should be after 8 weeks.
Amoxil, Clarithromycin and omeprazole for 2 weeks. Took it June and got better. But now have symptoms again and stool positive for HP antigen.