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Can Continuing Doxycycline And Stopping Flagyl Effective Cure For H.Pylori Infection?

Posted on Tue, 26 May 2015

Question: I am currently undergoing treatment for h. pylori, and possible ulcer. I am allergic to pcn and have history of svt with ablatuon in 2006. I still have pvcs and take labetalol for them. I also take citalopram for panic disorder along with alprazolam er and buspirone. I take low doses bc I am sensitive. the antibiotics I'm on are doxycycline and flagyl (generic), I am also on protonix. I am worried about the flagyl as it can prolong qt interval as well as citalopram. I had ekg today bc I was concerned and was having slow heart rate yesterday. they said it was ok. my pvvs have been worse though. could I stop the flagyl and cont doxycycline and still clear the h. pylori? I feel like I have to clear the infection but yet I don't want to put my heart at risk. also how many doses would it take for the prolongation of qt to show up. today was day 4 of treatment.

Answered by Dr. Rakesh Madhyastha (1 hour later)

Brief Answer:
Well tolerated

Detailed Answer:
Hello

Thanks for the query

It is true that metronidazole causes prolongation of qt interval but if you go through the literature many drugs including anti gastric medications are known to cause prolongation of qt. I have given flagyl to many of my cardic patients and they have tolerated the course well. Being from a tropical country many of my patients tend to get parastic infections requiring prolonged treatment with intravenous flagyl and they tolerate that as well.

If you want to stop flagyl then the only other alternative would be clarithromycin according to Guidelines however that is also known to cause qt prolongation.
Tinidazole can be used but that has shown cardio toxicity during animal testing.
Flagyl is important for the treatment of h pylori, you stand high risk of resistance if you do not use combination therapy

I hope I was of help, if you have any further queries please get back

Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Rakesh Madhyastha (12 minutes later)

generally how long on the drug does it take for the qt prolongation to occur if it will at all? would it be evident after four days?

Answered by Dr. Rakesh Madhyastha (1 hour later)

Brief Answer:
Immediate effect

Detailed Answer:
Hello

Thanks for getting back

Prolongation of QT occurs within a few hours of taking the drug. It will be evident after 4 days provided you will be still on it.

Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Rakesh Madhyastha (10 minutes later)

ok I had ekg today after 4 days of treatment so I was wondering if it would be evident by then,

Answered by Dr. Rakesh Madhyastha (7 minutes later)

Brief Answer:
Take your previous ekg

Detailed Answer:
Hello

Please take your any previous ekg and compare. It would be evident by now

Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Rakesh Madhyastha (33 minutes later)

ok thank you so much. They didn't tell me what the qt was but said it was "ok" or "normal"

Answered by Dr. Rakesh Madhyastha (22 hours later)

Brief Answer:
Normal qt

Detailed Answer:
Hello

If the qt was normal than any increase more 5ms is considered as significant after taking metronidazole.

Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Rakesh Madhyastha (59 minutes later)

5ms being 500?

Answered by Dr. Rakesh Madhyastha (12 hours later)

Brief Answer:
hello

Detailed Answer:
Hello

I meant .46 seconds or 460 milliseconds. For ease of use we take it as 500

Regards

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar