Treatment For H. Pylori Didn't Work. Now What?

Answer

Thanks so much for reaching out! Based on the medications you stated you are taking in your question (amoxicillin, clarithromycin, and Prilosec [omeprazole]), I'm assuming you are being treated for more than acid reflux.

That combination of medications (two antibiotics and a proton pump inhibitor) is a common treatment regimen for an H. Pylori infection. It is known as 'triple therapy' and is generally given for 14 days.

I don't know if you have been tested for H. Pylori, which was confirmed positive, or if your doctor has simply given you empiric treatment (assumed diagnosis, but not confirmed with testing).

Nevertheless, since you state you are continuing to have symptoms, it is important to discuss this with your doctor.

Assuming you are being treated for an active H. Pylori infection, studies suggest that nearly 20% of individuals fail initial treatment, so you aren't alone. 

In the next section, I discuss some options for the treatment of H. Pylori if you failed the initial treatment, which it seems like you may have.

H. Pylori Treatment Failure - Next Steps

As mentioned, failing initial treatment for H. Pylori isn't uncommon, and there are plenty of reasons why it could occur, including:

• Poor medication adherence


• Microbial resistance to antibiotics (common with clarithromycin)


• Inadequate suppression of stomach acid

The therapy you were started on (amoxicillin, clarithromycin, and Prilosec) is the most common initial therapy. If that fails, which could be for any of the reasons I mentioned above, there are alternative treatments available. These treatments include:

• Bismuth quadruple therapy: Bismuth subsalicylate, metronidazole, tetracycline, and a proton pump inhibitor (like Prilosec) given for 14 days


• Concomitant therapy: Clarithromycin, amoxicillin, metronidazole, and a proton pump inhibitor for 10-14 days


• Hybrid therapy: Amoxicillin and a PPI for seven days followed by amoxicillin, clarithromycin, a nitroimidazole, and a proton pump inhibitor for 7 days


• Levofloxacin triple therapy: Levofloxacin, amoxicillin, and a proton pump inhibitor for 10 to 14 days


• Levofloxacin quadruple therapy: Levofloxacin, omeprazole, metronidazole, and doxycycline for 10-14 days


• Levofloxacin sequential therapy: Amoxicillin and a proton pump inhibitor for five to seven days followed by levofloxacin, amoxicillin, metronidazole, and a proton pump inhibitor for 5-7 days.


• Rifabutin triple therapy: Rifabutin, amoxicillin, and a proton pump inhibitor twice daily for 14 days.

As you can see, there are plenty of alternative regimens you could try since your first treatment didn't work. I urge you to connect with your doctor about how you are feeling and to be re-evaluated.

Your doctor can perform tests to confirm your infection has been adequately treated. Tests include:

• Urea breath test
• Fecal antigen test
• Upper endoscopy

It is important to point out here too that generally a proton pump inhibitor, when used as part of a treatment plan to treat H. Pylori, should be given twice daily, especially if your first treatment ended in failure.

Final Words

I hope you found this answer helpful. I am making an educated guess about what you are treating based on the drugs you gave me, so please, if you have any further questions or clarifications to send my way, please do so.