Triple therapy and Prednisolone

[TheMoaningViolet]

As some of you may recall, I am doing (hopefully) the final taper, slowly reducing from 0.5 mg Prednisolone. I have just done 1:4 step and was feeling fine except that a few weeks ago, I have been diagnosed with symptomatic H Pylori infection and need to take triple therapy ( 2 antibiotics for 7 days, in my case Amoxicillin and Clarithromycin with Omperazole and then continue with Ompeprazole for another three weeks). When I went to see my GP a few weeks ago I had slight, sporadic symptoms and was planning to wait until I am off steroids, but now I feel nauseous all the time and can't sleep through the night, so something needs to be done, hence interfering with my taper seems inevitable.

Does anyone have any experience with combining antibiotics with Prednisolone and what would you advise me to do? I will need to take them twice a day, so morning and evening, and the pharmacist told me to take Omeprazole first (duh). When I asked about Prednisolone, she was not sure what my question was or didn't know the answer.

So, in the morning, after I take my Omeprazole, how should I space out Prednisolone and the antibiotics for the next week?

[PMRpro Ambassador]

I've never had any problem taking pred with an antibiotic - except a quinolone! I'd just extend the time you take on the taper, it is a very low dose you are on.

[TheMoaningViolet in reply to PMRpro]

Yes, I will stay on this step for now. I am worried that antibiotics will make me feel terrible and I won't be able to tell what's what if I continue to taper. Thank you.

[PMRpro Ambassador in reply to TheMoaningViolet]

There is no hurry ... take your time.

[TheMoaningViolet in reply to PMRpro]

I was telling my husband how I was at my best on 2 mg and now all my little pains are back and he said that anyone this side of 50 would benefit from 2 mg of steroids permanently, if only they were not so (potentially) problematic.

[PMRpro Ambassador in reply to TheMoaningViolet]

I don't think that 2mg pred long term is going to do much harm and I if I ever got near that would be it for me!! Prof Dasgupta feels 2-3mg is a good dose to prevent relapse - I just wish he'd say out loud in public that he thinks they last much longer than the mythical 2 years! If you can get lower than 2mg then you should because some people CAN get off but if you need 1 or 2mg to feel really well, I say go for it.

Best QOL is the aim.

[TheMoaningViolet in reply to PMRpro]

I am aiming to stop taking them soon. I have not had any significant problems with this taper and I am on 0.5 mg only. If I were in my 70s or if I was finding it difficult to reduce, I may have a different view.

[SheffieldJane]

I haven’t had a problem combining antibiotics with Pred. 2 mgs seems to be a good dose for you to be at. I suspect your symptoms are coming from the infection itself. Green Tea and or Ginger Tea might help you get over this hump. Nausea is miserable, I am experiencing it myself, including vomiting with little warning. Let’s hope this passes soon.

[TheMoaningViolet in reply to SheffieldJane]

I think the antibiotics are likely to make me feel sick, but it is only a 7-day course, so fingers crossed. x

[piglette]

I took about five antibiotics over a period of a couple of months. It did not dawn on me that I was taking steroids too, that might cause problems. It was just that I was taking other tablets I could not mix with each other. I had to take one lot of antibiotics four times a day, in the end I found it easier to take them at night as meals would not interfere with them either.

[TheMoaningViolet in reply to piglette]

I will take mine every 12 hours, so in reality this means breakfast and dinner and I take my steroids in the morning. I was thinking of taking the Omeprazole before breakfast, antibiotics during breakfast at 8 am and my steroid with coffee and a small snack at 10 am.

[piglette in reply to TheMoaningViolet]

So just two a day. Four a day was a bit much.

[Nanny71]

i also was prescribed 2 lots of antibiotics when diagnosed with H pylori after an Endoscopy.. 1 was on 9 mg steroids at the time.Took Lanzapresol 1st followed by Pred with breakfast. Followed by antibiotics soon after. No problems. Hope it goes well for you 🌺🌺

[TheMoaningViolet in reply to Nanny71]

Thank you I feel so much better already this morning

[HeronNS in reply to TheMoaningViolet]

I'm glad you're feeling better. I am, however, quite puzzled why your doctor would prescribe a PPI. Wouldnt that inhibit the absorption of the antibiotic?

In any case, you would be wise to consider taking some sort of probiotic between antibiotic doses, and continue for a few weeks after the course is over. This wiil greatly reduce the chance of developing C. diff. Take the probiotic (a capsule or, to my mind preferable, a good quality yoghurt or kefir) two hours away from any antibiotic. As far as I know the probiotic will not have any effect on other medications, but the antibiotic kills everything, including beneficial gut microbiome, so constantly replenishing the good microbes is a good thing to do.

My husband (not on pred) has just had to take combined antibiotics like you, only for a lung infection, and we gave him a high quality variety of kefir, which he will continue to take for a while. He finished his antibiotics about six days ago and seems well. At no point did the antibiotics make him feel worse. He felt considerably better within three days and continued to improve. When picking up his prescription I mentioned to the pharmacist this is what we were planning to do and she was wholeheartedly in favour, just saying (what I knew already) how to time the doses of probiotic so that it had time to work before the next antibiotic arrived!

[PMRpro Ambassador in reply to HeronNS]

It is a standard protocol and there is a good reason - it keeps the antibiotic where it is needed rather than sending it all over the body:

"PPIs have a very strong inhibitory effect of gastric acid secretion, resulting in the concentration of antibiotics in the stomach. These two effects might contribute to elevate the anti- H. pylori activity in the hostile environment."

emedicine.medscape.com/arti...

[HeronNS in reply to PMRpro]

Oh, so it's standard for this particular issue?

[PMRpro Ambassador in reply to HeronNS]

One of the standards but probably the most used.

[TheMoaningViolet in reply to HeronNS]

Yes, I realise my gut flora will be decimated, but once the symptoms became intolerable, I had no choice than to take the antibiotics. I am taking a prebiotic supplement in raw form (a drink) before lunch and a glass of goat's kefir as well. I will consider the pills once I stop taking the antibiotics, as I would be throwing my money down the drain if I tried this now.

I guess the PPIs are prescribed partly as a stomach protection when taking strong medication, not dissimilar to our own experience with steroids, but in the case of H Pylori they have an additional role of reducing the stomach acidity for a few weeks afterwards to allow the stomach lining to heal more quickly. These little creatures live in our stomach where they burrow into the lining and are implicated in the formation of stomach ulcers and in some cases stomach cancers. So, best to get rid of them, though they seem to happily live in a large percentage of the world's population, not always causing any significant symptoms.

Zoe are starting their gut testing in the UK from July, so I may try that and see what my gut flora looks like a few months from now.

[HeronNS in reply to TheMoaningViolet]

The point I was trying to make is that eating a probiotic food between antibiotic doses is not wasted. Prebiotics, I thought, were some kinds of food, some vegetables for example? Food for the microbes to flourish?

[Karenjaninaz in reply to HeronNS]

A PPI is the protocol for part of the h pylori treatment. It likes the acid environment hence acid blocker. I actually had the same treatment way before covid.

Not sure probiotics will survive the abx onslaught but useful when the treatment is over.

[HeronNS in reply to Karenjaninaz]

It is supposed to be useful to continually replenish the microbiome throughout antibiotic treatment. Aware that it is also continually wiped out, but anything which reduces the chance of C. diff. caused by today's rather lethal antibiotics seems like a good plan to me! Certainly it can do no harm. And for sure carry on after the antibiotics are finished.

[Karenjaninaz in reply to HeronNS]

My gastro recommended Florastor (Saccharomycetes boulardii CNCM-745) This is available without Rx. This is a yeast based probiotic not affected by antibiotics.

There is no consensus on bacterial probiotics. There is no regulation and well run studies on efficacy.

Come to think of it; if a person uses bacterial probiotics while using antibiotics could those too become resistant strains?

[HeronNS in reply to Karenjaninaz]

I don't know. But if they're beneficial, does it matter? You aren't repopulating the gut with the disease-causing entities, but with the ones which are necessary for our health, indeed our ability to digest food. The idea is to prevent the disease-causing ones from getting a foothold. C. difficile has become a problem and frankly I'd prefer to take my chances with a normal probiotic than end up needing a fecal transplant!