Since your stool antigen test is negative, H. pylori is fully eradicated — no second line treatment needed. Ongoing occasional symptoms after 1.5 years are likely functional dyspepsia or post-infectious IBS. Take a PPI like pantoprazole for 4 weeks, add probiotics, avoid spicy/oily food and stress. No more antibiotics needed.

Second-line treatment” means a different combination of antibiotics and acid-suppressing medication used only if the first H. pylori treatment fails or the infection is still present. Since you completed a 14-day course and your stool antigen test is negative, H. pylori has most likely been eradicated. Occasional symptoms after eradication are common and may be due to gastritis, acid reflux, functional dyspepsia, or another gastrointestinal condition rather than persistent H. pylori. If symptoms continue or worsen, consult a gastroenterologist for evaluation. An upper GI endoscopy may be considered, especially at your age or if you have weight loss, anemia, vomiting, difficulty swallowing, or bleeding. Avoid self-medicating with antibiotics unless repeat testing confirms reinfection.

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A negative H. pylori stool antigen test after completing a full 14-day treatment generally means that the infection has been successfully eradicated, provided the test was done at least 4 weeks after antibiotics and at least 2 weeks after stopping proton pump inhibitors (PPIs). Regarding your question about "second-line resistance": Resistance means the H. pylori bacteria are not killed by one or more antibiotics because they have developed the ability to survive those medications. Second-line treatment is only needed if the first treatment fails and the infection is still present on repeat testing. If the stool antigen test is negative, there is no evidence that H. pylori is still present, so antibiotic resistance is not a likely explanation for your current symptoms. Why are you still having occasional symptoms? Even after H. pylori has been eradicated, some people continue to experience symptoms due to reasons such as: Functional dyspepsia (sensitive stomach without an ongoing infection) Acid reflux (GERD) Gastritis that takes time to heal Dietary triggers (spicy, oily, acidic foods, caffeine, alcohol) Stress or anxiety, which can worsen stomach symptoms Less commonly, other gastrointestinal conditions that need evaluation Since your: ✔ H. pylori stool antigen is negative, ✔ 14-day treatment was completed, ✔ Blood tests are normal, ✔ Symptoms are only occasional after 1½ years, repeating H. pylori antibiotics is not recommended unless testing becomes positive again or your doctor has another reason to suspect reinfection. What should you do now? Consult a gastroenterologist if symptoms persist or become more frequent. Maintain regular meal timings and avoid foods that trigger your symptoms. If symptoms are suggestive of acidity, your doctor may recommend a short course of a PPI or another acid-suppressing medication. If you develop any alarm symptoms—such as weight loss, difficulty swallowing, persistent vomiting, black stools, vomiting blood, or anemia—you should undergo an upper GI endoscopy promptly. If symptoms are recurrent despite treatment, your gastroenterologist may consider an upper GI endoscopy to look for gastritis, ulcers, reflux disease, or other causes.