Effectiveness of two quadruple, tetracycline‐ or clarithromycin‐containing, second‐line, Helicobacter pylori eradication therapies

Abstract

Background: There are no guidelines on second‐line therapies for Helicobacter pylori eradication failures of omeprazole–clarithromycin–amoxicillin triple therapy. Aim: To compare the efficacy of two second‐line therapies for persistent H. pylori infection. Methods: Over a 6‐year period, patients with persistent H. pylori infection following omeprazole–clarithromycin–amoxicillin eradication therapy were randomized to receive omeprazole, 20 mg twice daily, bismuth, 120 mg four times daily, metronidazole, 500 mg twice daily, and either tetracycline, 500 mg four times daily, or clarithromycin, 500 mg twice daily, given for 7 days. Before therapy, patients underwent endoscopy with biopsies for histology, culture and antibiotic susceptibility tests. H. pylori infection was confirmed by histology. Results: Of the 95 randomized patients, 88 (93%) completed the study. Age, sex, smoking, ulcer/non‐ulcer dyspepsia ratio and antibiotic resistance were not significantly different between the treatment groups. On intention‐to‐treat analysis, eradication was achieved in 41 of the 49 patients (84%; 95% confidence interval, 70.4–92.7%) and 27 of the 46 patients (59%; 95% confidence interval, 43.3–73.0%) of the tetracycline‐ and clarithromycin‐containing groups, respectively (P=0.007). On multivariate regression analysis, the sensitivity of H. pylori to metronidazole had a likelihood ratio of 5.2 (P=0.022), followed by the type of quadruple therapy (likelihood ratio, 4.4; P=0.036). Conclusions: Tetracycline‐containing quadruple rescue therapy is highly effective in treating H. pylori eradication failures of the omeprazole–amoxicillin–clarithromycin regimen.

Posttreatment 13C-urea breath test is predictive of antimicrobial resistance to H. pylori after failed therapy

“…Our study once again illustrates a hazard in clinical practice, and thus further supports the clinical demand for an addition tool to evaluate posttreatment antimicrobial resistance. As quadruple therapy is the common rescue regimen for failed triple therapy, [13][14][15] it is clinically indicated to test whether the posttreatment value of the urea breath test is related to the outcome of rescue therapy. As shown in Table 3, 1-week quadruple therapy, serving as a rescue regimen, had a 93.8% eradication rate by per-protocol analysis for residual H. pylori, when the posttreatment ECR of the urea breath test was not more than 15, indicating a scanty bacteria load in the stomach.…”

“…Moreover, it may improve the selection of the rescue regimen in primary clinics where routine H. pylori culture is not available. As patients with failed triple therapy need an effective rescue regimen, [13][14][15] this study tests whether the posttreatment value of the 13 C-urea breath test can allow physicians to choose a rescue regimen without using an invasive biopsy method. As a secondary aim, we evaluated, in a second sample of patients, the value of the pretreatment 13 C-urea breath test results for predicting clarithromycin resistance.…”

A 10‐day levofloxacin‐based triple therapy in patients who have failed two eradication courses

“…7 Nevertheless, bacterial eradication may fall in up to 40% of cases after the suggested second-line regimens and doctors who treat this infection are often faced with a certain number of patients for whom two treatment attempts have failed. [10][11][12][13][14] Furthermore, a progression of H. pylorirelated chronic active gastritis towards atrophy, intestinal metaplasia and gastric cancer has also been reported suggesting that further attempts to cure the infection are worthwhile. 15 Currently, a standard thirdline treatment is lacking, and European guidelines recommend culture in these patients to select a thirdline treatment according to microbial sensitivity to antibiotics.…”

Short-term Celecoxib intervention is a safe and effective chemopreventive for gastric carcinogenesis based on a Mongolian gerbil model

“…Despite this, although the eradication of H pylori is still the most cost-effective method for prevention of gastric carcinogenesis, the antibiotic treatment of H pylori infection is confronting a significant challenge associated with resistance to antibiotics. The first-line regimen continues to have a 10%-23% failure rate [5][6][7][8][9][10] . Unfortunately, several studies have shown that rescue regimens have failed in 5%-63% of patients whose H pylori cannot be eradicated by standard PPI-based triple therapies [11,12] .…”