H. pylori and Prevacid necessity

[LDJ32]

I need to know if in the absense of an ulcer, or even significant digestive distress, is antacid therapy with something like Prevacid necessary for the actual killing of the H. pylori when taking a dual antibiotic therapy?

In that H. pylori produces urease and by products which leads to neutralization of stomach acid (so it doesn't seem to like acid), for the sole purposes of killing the H. pylori is the antacid therapy a true necessary?

I understand that H. pylori is usually treated due to ulcers or other severe stomach distress. But that is not my case. I do not have an ulcer or severe stomach related symptoms (but I have had mild, chronic dyspepsia for years). I have been tested and show evidence of H. pylori infection.

I am working with a cardiologist who is looking at a recent study from Milan that found a link between H. pylori and atrial fibrilation. I have tried various heart meds and my only other option at this point is a very expensive operation which I cannot afford due to no health insurance. We have decided that it is worth a try with erradicating the H. pylori to see if this alters the Afib.

I have a severe case of Afib which is only very inadequately controlled by medication (currently a combo of Verapimil and low dose digoxin which has proved to be my most effective medications). A wide number of food intolerances are what make the difference between me fluxuating between sinus rhythm (only occassionally) and mild Afib (70-90 bpm)and very erratic Afib/tachycardia of 120-190 bpm 24/7. And this is with medication. This food connection has baffled my cardiologist.

We are considering a triple drug therapy of lansoprazole (Prevacid), amoxicillin, and clarithromycin (Biaxin). I have a concern with expense (esp. Prevacid)but more importantly keeping the drug load on my system as low as possible. I want as few meds as possible to get the job done.

I also have a concern with amoxicillin as I understand that H. pylori can rapidly develop resistance to antibiotics. Due to dental work I was on a 14 day, 500 Mg course of amoxicillin in December (no effect on the Afib). This seems like half the current recommended dosage for H. pylori. I am  concerned that this may have been just enough to produce a resistant H. pylori. Any thoughts on this?

Are there any alternate meds recommended if the amoxicillin is a problem?

I know this is a bit unusual, but please, I am looking for specific information. I will then take this to my cardiologist so that we can make a more informed choise.

Thanks.
LDJ

[Kevin Pho, MD]

The triple drug therapy suggested (Prevacid, Amox, Biaxin) is normally the first choice for treatment.  

If the Prevacid is a cost issue, you can consider other PPIs, such as Prilosec (over-the-counter in the US), Protonix, or Aciphex.  

If a PPI is not feasible, you can consider a non-PPI regimen.  The only one suggested is a combination of Bismuth, metronidazole, tetracycline and an H2-blocker (i.e. Pepcid or Zantac).

If amoxcillin is a problem, you can consider the regimen outlined above, or a combination of metronidazole/biaxin/PPI.

These options can be discussed with your personal physician.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
http://www.straightfromthedoc.com

[yoshi]

triple drug therapy suggested (Prevacid, Amox, Biaxin) is sold as PREVPAK and it lasts 14 days.

[NYReflux]

Why Stomach Acid is Good For You,  BY Johnathan V. Wright. It's a book that helped me with my chronic acid reflux.  You can see what will help you with your infection.  Check out P.124.  This book has been so helpful to me that I have been medicine free for three days.  You can see my entry on 8/15/05 called chronic reflux.  Best of luck.  Of course talk to your DR. before you start taking any alternative medicines.

[Alex Dobrody]

The original post contained this question:
Are there any alternate meds recommended if the amoxicillin is a problem?
Actually, I have a lot of issues with "triple therapy" to start with. The whole H. pylori story is very unclear. If it's a pathogen, why is it that only a minority of people who have it ever develop an ulcer? It does not invade epithelium cells, so how can it be a pathogen. And it does not even fulfil the four classic Koch's postulates to be classified as a pathogen! How come there's so much fuss about its elimination?!
I asked many doctors about this, but never got a straight answer. And the side effects of both antibiotics and PPIs are just awful! Have you heard about lethal pseudomembranous colitis caused by antibiotics?
The answer to your question is yes - there are some effective alternative treatments. Consider mastic gum, Manuka honey from New Zealand and extra virgin pine nut oil from Siberia. I personally know people who have been helped by all three. And ask those questions to your doctor - you will have some fun, believe me!

[cuprex]

Hi Yoshi   2 years or so ago I was asking about irregular heart beat..
You had told me H Pylori due to the swimming I was doing, like an idiot instead of following up on your advice, my cardioligist convinced me there was no connection..
Yeh Right!!! I read the Italian study and I absolutly had the H Pylori... So I guess you were spot on...
So Acifex and the 2 antibiotics for 10 days and even chewing some mastic gum to make sure..
I could not believe that it actually dissapeared, but after 3 weeks it seems to have come back..
I havnt tested for H Pylori, but Im interested to know if perhaps its the acid..
Is it possible that the H Pylori and the acid weaken the integretary of the stomach wall and
expose the Vagas to react because of the stomach.. Like cold water, kind of touching the Vagas and setting off the irregular phase....

[GinaO]

I am currently being treated for H. Pylori taking the triple therapy. So far no side effects. My biggest worry is my children and husband having it and giving it back to me. My  family doctor informed me today that I could contact it through someone,s silva in the air. I think she's brian dead. She said if my family has it (husband, kids) she will not treat them.my kids are 16 and 18 years old. I have an unusual amount of inflammation in my stomach and upper bowel for my age according to my specialist. How is my gasteritis able to cure if I get it back from my husband. You can't tell my family doctor anything . She's right and that's that. I hope they find a vaccine for this soon so we can stop suffering and and live life without pain or worry.

[pacetiger]

I think your family should be tested and treated if necessary.  Sounds like you need a new family doctor.