Case - 150916 - Resistant to treat H.Pylori - what to do?

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15 Sep 2016 - General

A middle aged gentleman, with background history of hypertension, heavy smoker, increased body mass index, depression, was initially referred by his General practitioner for a gastroscopy due to on-going symptoms of epigastric burning pain, reflux, with some element of vague dysphagia, and reduced in appetite. Gastrosocpy was done with showed moderate gastritis and moderate duodenitis, and Clo-test was postive for Helicobacter Pylori infection. Patient was given a course of triple therapy for H.Pylori eradication. An urea breath test was done 4 weeks after the triple therapy, was positive. Patient was given a quadruple therapy for eradication for H.pylori infection for the second time. Again, 4 weeks after, patient was tested positive with urea breath test and no symptomatic improvement. What will be your next step in his management ?? 

In case of treatment failure, the clinician should avoid using antibiotics employed in previous treatment regimens. Because of the expense and lack of availability, culture and antibiotic sensitivity testing are typically not performed unless a patient has failed at least 2 courses of therapy. Even in this circumstance, the usefulness of such testing is arguable as there is no evidence to suggest that choosing a salvage regimen based upon an understanding of the patient’s previous antibiotic exp...
 (Total 115 words)