BACKGROUND: Helicobacter pylori eradication therapy with a proton pump inhibitor (PPI), clarithromycin, and amoxicillin fails in >20 % of cases. A rescue therapy with PPI-amoxicillin-levofloxacin still fails in >20 % of patients. AIM: To evaluate the efficacy and tolerability of a bismuth-containing quadruple regimen in patients with two consecutive eradication failures. METHODS: Prospective multicenter study of patients in whom 1st treatment with PPI-clarithromycin-amoxicillin and 2nd with PPI-amoxicillin-levofloxacin had failed. A 3rd eradication regimen with a 7- to 14-day PPI (standard dose b.i.d.), bismuth subcitrate (120 mg q.i.d. or 240 mg b.i.d.), tetracycline (from 250 mg t.i.d. to 500 mg q.i.d.) and metronidazole (from 250 mg t.i.d. to 500 mg q.i.d.). Eradication was confirmed by (13)C-urea-breath-test 4-8 weeks after therapy. Compliance was determined through questioning and recovery of empty medication envelopes. Adverse effects were evaluated by means of a questionnaire. RESULTS: Two hundred patients (mean age 50 years, 55 % females, 20 % peptic ulcer/80 % uninvestigated-functional dyspepsia) were initially included, and two were lost to follow-up. In all, 97 % of patients complied with the protocol. Per-protocol and intention-to-treat eradication rates were 67 % (95 % CI 60-74 %) and 65 % (58-72 %). Adverse effects were reported in 22 % of patients, the most common being nausea (12 %), abdominal pain (11 %), metallic taste (8.5 %), and diarrhea (8 %), none of them severe. CONCLUSION: A bismuth-containing quadruple regimen is an acceptable third-line strategy and a safe alternative after two previous H. pylori eradication failures with standard clarithromycin- and levofloxacin-containing triple therapies.
BACKGROUND:Helicobacter pylori eradication therapy with a proton pump inhibitor (PPI), clarithromycin, and amoxicillin fails in >20 % of cases. A rescue therapy with PPI-amoxicillin-levofloxacin still fails in >20 % of patients. AIM: To evaluate the efficacy and tolerability of a bismuth-containing quadruple regimen in patients with two consecutive eradication failures. METHODS: Prospective multicenter study of patients in whom 1st treatment with PPI-clarithromycin-amoxicillin and 2nd with PPI-amoxicillin-levofloxacin had failed. A 3rd eradication regimen with a 7- to 14-day PPI (standard dose b.i.d.), bismuth subcitrate (120 mg q.i.d. or 240 mg b.i.d.), tetracycline (from 250 mg t.i.d. to 500 mg q.i.d.) and metronidazole (from 250 mg t.i.d. to 500 mg q.i.d.). Eradication was confirmed by (13)C-urea-breath-test 4-8 weeks after therapy. Compliance was determined through questioning and recovery of empty medication envelopes. Adverse effects were evaluated by means of a questionnaire. RESULTS: Two hundred patients (mean age 50 years, 55 % females, 20 % peptic ulcer/80 % uninvestigated-functional dyspepsia) were initially included, and two were lost to follow-up. In all, 97 % of patients complied with the protocol. Per-protocol and intention-to-treat eradication rates were 67 % (95 % CI 60-74 %) and 65 % (58-72 %). Adverse effects were reported in 22 % of patients, the most common being nausea (12 %), abdominal pain (11 %), metallic taste (8.5 %), and diarrhea (8 %), none of them severe. CONCLUSION: A bismuth-containing quadruple regimen is an acceptable third-line strategy and a safe alternative after two previous H. pylori eradication failures with standard clarithromycin- and levofloxacin-containing triple therapies.
Authors: W M Wong; Q Gu; S K Lam; F M Y Fung; K C Lai; W H C Hu; Y K Yee; C K Chan; H H X Xia; M F Yuen; B C Y Wong Journal: Aliment Pharmacol Ther Date: 2003-02-15 Impact factor: 8.171
Authors: D C Wu; P I Hsu; A Chen; K H Lai; F W Tsay; C J Wu; G H Lo; J Y Wu; I C Wu; W M Wang; H H Tseng Journal: Eur J Clin Invest Date: 2006-11 Impact factor: 4.686
Authors: Sung Chul Park; Hoon Jai Chun; Sung Woo Jung; Bora Keum; Woo Sik Han; Rok Son Choung; Yong Sik Kim; Yoon Tae Jeen; Hong Sik Lee; Soon Ho Um; Sang Woo Lee; Jai Hyun Choi; Chang Duck Kim; Ho Sang Ryu; Jin Hai Hyun Journal: Korean J Gastroenterol Date: 2004-09
Authors: G Cammarota; A Martino; G Pirozzi; R Cianci; G Branca; E C Nista; A Cazzato; O Cannizzaro; L Miele; A Grieco; A Gasbarrini; G Gasbarrini Journal: Aliment Pharmacol Ther Date: 2004-04-01 Impact factor: 8.171
Authors: José M Navarro-Jarabo; Nuria Fernández; Francisca L Sousa; Encarnación Cabrera; Manuel Castro; Luz M Ramírez; Robin Rivera; Esther Ubiña; Francisco Vera; Isabel Méndez; Francisco Rivas-Ruiz; José L Moreno; Emilio Perea-Milla Journal: BMC Gastroenterol Date: 2007-07-25 Impact factor: 3.067