Should I extend H. pylori treatment after a dosing mistake?

Question

Hello doctor,

I am in my 9th day of 14 days of H. pylori treatment with Amoxicillin 1 g BD, Clarithromycin 500 mg BD, and Pantoprazole twice daily.

Unfortunately, I have been taking only 500 mg of Amoxicillin twice daily for 8 days, missing only the half dose that was prescribed in the medication. There were no missed doses, but I took half the Amoxicillin prescribed. Now I am back to the correct dose from the 9th day onwards.

I have some bloating problem, but no fever, severe pain, vomiting, or burning sensation. Could you kindly help me out in the following questions:

1. Should I continue as it is until the completion of 14 days?

2. Do I require an extended antibiotic course?

3. After this how do I book my stool antigen test?

Please guide.

Answer 1

Hi,

Welcome to icliniq.com.

I understand your concerns.

The present triple therapy for H. pylori is a combination of Amoxicillin, Clarithromycin, and Pantoprazole.

Since you took 500 mg of Amoxicillin instead of 1 g two times a day for the first eight days without missing any doses, you already have partial exposure to the medication. Since you started taking the correct dosage from day nine onwards, it would be wise to continue with the remaining seven days of the 14-day regimen.

Extending the use of antibiotics is generally not necessary, provided that the whole plan is fulfilled appropriately from this moment on. In case you develop symptoms or positive tests, your healthcare provider may recommend a second-line eradicative strategy.

Bloating is frequent in many patients undergoing therapy caused by the effects of antibiotics on gut bacteria. This will generally not be a problem, unless you start experiencing severe abdominal pain, fever, continuous vomiting, and bleeding.

Testing for eradication should ideally be performed at least four weeks following completion of the medications, as well as discontinuing proton pump inhibitors such as Pantoprazole for two weeks.

Currently, you should:

Take the total treatment for two weeks (14 days).

Do not stop Pantoprazole early during therapy.

Consider taking probiotics if bloating becomes bothersome.

If the follow-up test remains positive, your gastroenterologist can prescribe an alternative eradication regimen. It is expected that most people get successful eradication through proper treatment and confirmation tests.

I hope you find this information useful; please give your opinion. All the best.

Thank you.