What should I do if the eradication of Helicobacter pylori fails?

The failure of eradicating Helicobacter pylori can be addressed by adjusting medication regimens, improving drug resistance testing, combining gastric mucosal protective treatment, strengthening lifestyle management, and regular follow-up examinations. The failure of Helicobacter pylori eradication is usually related to bacterial resistance, improper medication, abnormal gastric environment, host immune factors, adverse drug reactions, and other factors.

1. Adjust medication regimen

After initial treatment failure, it is necessary to change the antibiotic combination to avoid repeated use of the same medication. It is recommended to use quadruple therapy with bismuth containing agents, such as bismuth potassium citrate combined with amoxicillin capsules, clarithromycin tablets, and omeprazole enteric coated capsules. Before treatment, it is recommended to conduct a drug sensitivity test through gastric mucosal biopsy and select sensitive antibiotics accordingly. During the medication period, strictly follow the doctor's advice to complete the 14 day course of treatment, and do not reduce or interrupt on your own.

2. Improve drug resistance testing

Determine bacterial resistance to commonly used antibiotics such as clarithromycin and levofloxacin through carbon-13/14 breath test combined with gastroscopy tissue culture. If clarithromycin resistant strains are detected, macrolide drugs should be avoided and furazolidone tablets can be used as a substitute. For metronidazole resistant patients, tetracycline antibiotics such as doxycycline hydrochloride tablets can be used for remedial treatment.

3. When combined with gastric ulcer or erosive gastritis, mucosal protectants such as magnesium aluminum carbonate chewable tablets and rabeprazole tablets should be added. Excessive gastric acid secretion can prolong the use period of proton pump inhibitors, such as extending the medication time of esomeprazole magnesium enteric coated tablets to 8 weeks. Simultaneously supplementing with compound vitamin B tablets improves the ability of gastric mucosal repair and reduces the irritation of antibiotics on the gastrointestinal tract.

4. Strengthen life management

During treatment, drinking and smoking are prohibited, and spicy and stimulating foods are avoided. The serving of individual dishes shall be implemented to prevent cross infection in the family, and the tableware shall be boiled and sterilized regularly. Maintain a regular schedule and reduce the impact of mental stress on gastrointestinal function. It is recommended that family members screen for Helicobacter pylori simultaneously, and those who test positive should be treated together to reduce the risk of reinfection.

5. Regular follow-up

After completing remedial treatment, repeat carbon-13 breath test at intervals of more than 4 weeks. If the second cure fails, gastroscopy examination should be performed to evaluate the degree of mucosal lesions, and if necessary, histological testing and bacterial culture should be performed. Those who fail three treatments may consider sequential therapy or mixed therapy, and develop individualized plans under the guidance of gastroenterologists. After the failure of radical treatment, dietary habits should be reassessed, reducing the intake of pickled and fried foods, and increasing the intake of fresh vegetables and fruits to supplement vitamin C. Moderate consumption of probiotic foods such as yogurt and natto can regulate gut microbiota, but should be taken 2 hours apart from antibiotics. Maintain moderate exercise to enhance immunity and avoid overexertion. During the treatment period, if serious adverse reactions such as diarrhea and rash occur, timely follow-up visits should be made to adjust medication. Follow up every 6-12 months after completing treatment to monitor for recurrence.