I completed the 14 day H. Pylori eradication protocol:
- every 6 hours, 1 hour before meals: 10mg Rabeprazole (so it is absorbed before Bismuth)
- every 6 hours with meals: 500mg Amoxicillin, 120mg Bismuth Oxide (as a Bismuth Subcitrate De-Nol)
- 1500mg Metronidazole/day, spread out over the 4 dosing times: 250mg, 500mg, 500mg, 250mg
This is similar to the drug formulation Pylera, but the Tetracycline is substituted with Amoxicillin, and the PPI is dosed 4 times in 24 hours instead of twice daily. The only PPI that I have seen in studies dosed in that way is 10mg Rabeprazole, so don't assume any PPI or dose will do.
Side effects:
- nausea from day 5 to 14. The suspect here is Rabeprazole or the reduction of digestion caused by it. It is also possible that the antibiotics are irritating to the intestinal mucosa, which manifests as nausea. The nausea was so nasty that I was considering stopping the regimen after day 7. Then I started taking 25mg Meclizine, which suppressed the nausea somewhat but was making me drowsy. One time I tried 1/8 teaspoon ginger powder and it did suppress the nausea - ginger may interact with the drugs and may irritate the stomach mucosa, so I used it only one time instead of Meclizine. The last days I started eating only bread, steamed microwaved broccoli, cauliflower, carrots, salt, and olive oil and that magically decreased the nausea to more tolerable level so I didn't have to take anything for it.
- occasional brown tea colored urine - Metronidazole is noted in studies to do that. It doesn't seem to be kidney damage because there were no kidney aches, no change in urination frequency and volume, and the brown coloring stopped the moment I finished the course.
- frequent headaches - suspecting Rabeprazole or Metronidazole. I had to take 400mg Ibuprofen on several days to suppress the headaches.
- forgetfulness - forgetting to take doses, the dose I took, or forgetting to write it down. I suspect Metronidazole since it is known to affect the nervous system - can cause neuropathy.
My diet was very bland and mostly carbohydrates: bread, pasta, mashed potatoes from potato flakes powder (no milk), steamed vegetables, salt, olive oil, red pepper, some rice (but felt heavy nausea on it).
Do not eat milk, whey protein, milk products (cheese, yogurt, butter) since the calcium in them may neutralize some antibiotics.
I will continue the Bismuth Subcitrate for additional 2-4 weeks - it helps the intestinal mucosa heal. I started taking probiotic pearls in the last few days of the antibiotics and will continue taking them daily - these protect from a surge of Clostridium Difficile, which can cause severe diarrhea after antibiotics.