TWR Posted July 12, 2016 This female patient has been treated twice in 3 months for H. Pylori with standard Prevpak. Today's test of cure with breath test was positive again. She has no abdominal discomfort. She is frustrated and so am I. Allergic to Azithromycin by history. Any ideas? Thanks
Reality Check 2 Posted July 12, 2016 Stool H. Pylori? Scope w biopsy? Yes, the only good HPylori is a dead one, but are you willing to risk CDiff to chase a phantom? Need more details or detailed testing.
thinkertdm Posted July 12, 2016 AFP showed this "Urea breath testing is one option for test of cure and should be performed four to six weeks after completion of eradication therapy." So, figure ten days of therapy, then four to six weeks after that leads you to nearly month 2, but your post would suggest she has been treated twice. Would recommend giving more time or rethinking the differential. Is she symptomatic? You mention abdominal discomfort, not sure if you meant symptoms or complications from the abx.
electric130 Posted July 12, 2016 I always get a stool h pylori before saying they have a resistant and persistent infection especially if asymptomatic. Eradication rate is better with pylera, I would not treat with prevpak again, pretty high resistance rate.
newton9686 Posted July 12, 2016 Yeah break out the bigger antibiotics. Patient needs a cure and you need documentation so your not paying for a new beach house if the patient is diagnosed with an gastric adenocarcinoma in the future.
TWR Posted July 12, 2016 Author Pylera would probably do the trick. Except it is $675 with discount coupon for 10 day Pak.! Gotta luv capitalism!!
thinkertdm Posted July 12, 2016 Just to clarify- was the "test for cure" done after an appropriate follow up interval with appropriate medication compliance? Also, after two failures of anything, I would either refer to a specialist, actively consider other potential causes for any symptoms, or both, before just blindly giving a third round of antibiotics.
Boatswain2PA Posted July 13, 2016 Pylera would probably do the trick. Except it is $675 with discount coupon for 10 day Pak.! Gotta luv capitalism!! Without capitalism we probably wouldn't HAVE that medicine. Eventually that medicine will be cheap and may help millions. Capitalism rocks!
TWR Posted July 13, 2016 Author Boatswain, I am all over capitalism. I owned 5 businesses before and during my medical career. I just object to such a cost that insurance won't cover. I know about R&D costs and trials etc. By the time it becomes affordable our grandchildren will afford it. Falls in the same category as the 10ml acetic acid 2% and hydrocortisone 1% (otic drops) for $169. $16.90 an ounce. Please!!!!!!!! that is not capitalism, that is rape! PS won't even talk about Cancer drugs! Some are in the thousands a month. (Hmm this has nothing to do with the original question, sorry)
kittykatufl Posted July 13, 2016 Was the testing for eradication at least 4-6 weeks after completing therapy? If not this can lead to both false positive and negatives. Pylera works well but you can also order the abx seperately or use doxycycline instead of tetracycline to bring down the cost. Sequential therapy with amoxicillin, clarithromycin and tinidazole. There are numerous therapies for 2nd and 3rd line treatment.
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