Hi!

First of all - I assume you're not on any NSAIDS (ibuprofen etc) -
these may exacerbate your symptoms (due to decreased secretion of
mucus and bicarbonate).

Other risk factors for your disease include smoking and stress.

If you have reflux problems over a long period of time, your esophagus
will be pretty irritated - this should be avoided by all means (e.g.
do not lie down after meal, eat healthy food etc). From my point of
view, there are good reasons for eradicating H pylori when you have
such problems (despite no ulcers detected). This is because the
bacteria is strongly linked to peptic ulcer disease and duodenal ulcer
(H pylori produces among others a cytotoxin which breaks down mucosal
defenses).

How to treat H pylori infection?

TRIPLE therapy is required to achieve optimal clinical outcome.

You didn't mention anything about the doses of amoxicillin and
clarithromycin that you were given.

However, a well-tested regimen consists of 250 mg clarithromycin and
500 mg amoxicillin - both given 3 times a day. Additionally a proton
pump inhibitor (PPI) should be given (e.g. omeprazole 20 mg twice
daily). This regimen has been shown to result in 80% eradication rate
of H pylori when treated over 7 days (SIGN guidelines).

FDA (US) however, suggests a slightly different regimen:
amoxicillin 1 g, clarithromycin 500 mg, and lanzoprazole 30 mg - all
given twice daily for 14 days (90-95% eradication rate of H pylori).

It is important that you take the PPI (omeprazole etc) BEFORE meals.
The antibiotics should be taken with food.

Your H pylori may have developed resistance to the penicillins you
were put on (have this been checked or is it just your physician's
suggestion..?) due to the short treatment you were put on (to short
therapy could theoretically just knock out the bacteria that are
highly susceptible to the antibiotics while the more resistant
bacteria survive - this is then followed by formation of the "more
resistant" bacteria resulting in a H pylori culture which is actually
more resistant than before therapy was commenced).

It might be worth to try a regimen which includes metronidazole.
However, it should be ruled out if your H pylori is resistant to
clarithromycin or amoxicillin (or both). If it is still susceptible to
clarithromycin, you could be started on metronidazole 400 mg and
clarithromycin 250 mg - both three times a day - and e.g. lanzoprazole
30 mg twice daily - over 7 days (SIGN guideline suggestions).

Rgds,
Oistein Thomassen
Clin Pharm (MSc)

Your doc. should have added a PPI to the antibiotic combination she treated
you with...Pretty stupid if u ask me.