Q: My 86 years old mother was diagnosed with H. pylori infection. She vomited for three days prior to the doctor's appointment. Now she has diarrhoea and nausea. She cannot tolerate the tetracycline that was prescribed but she is taking the Flagyl and acid reducer. She is allergic to so many antibiotics. I read that Pepto Bismal had an ingredient that would kill H. pylori? What do you recommend that we should do? She is very uncomfortable. She says that her stomach seems to be rolling and feels very unsettled.

A:There are many regimens for eradicating H. pylori infection. Basically either two or three medicines have to be consumed over 7 to a maximum of 14 days. In dual drugs therapy, omeprazole or ranitidine bismuth citrate is given along with either amoxycillin or clarithromycin for 14 days with as cure rate of 80 to 92%. In triple therapy omeprazole or lansoprazole is given with two antibacterials such as amoxycillin and clarithromycin or clarithromycin with metronidazole (Flagyl) or tinidazole. The use of tetracycline is not in vogue which is used along with tripotassium dicitrato bismuthate and metronidazole and is poorly tolerated. Antibiotics other than tetracycline listed above belong to other groups. Hopefully the patient should have little problem is tolerating the therapy. It is also possible that the patient is also intolerant to metronidazole (Flagyl); if so a regimen which excludes both metronidazole and tetracycline can be given.