Third-line rescue therapy for Helicobacter pylori infection

Abstract

H pylori gastric infection is one of the most prevalent infectious diseases worldwide. The discovery that most upper gastrointestinal diseases are related to H pylori infection and therefore can be treated with antibiotics is an important medical advance. Currently, a first-line triple therapy based on proton pump inhibitor (PPI) or ranitidine bismuth citrate (RBC) plus two antibiotics (clarithromycin and amoxicillin or nitroimidazole) is recommended by all consensus conferences and guidelines. Even with the correct use of this drug combination, infection can not be eradicated in up to 23% of patients. Therefore, several second line therapies have been recommended. A 7 d quadruple therapy based on PPI, bismuth, tetracycline and metronidazole is the more frequently accepted. However, with second-line therapy, bacterial eradication may fail in up to 40% of cases. When H pylori eradication is strictly indicated the choice of further treatment is controversial. Currently, a standard third-line therapy is lacking and various protocols have been proposed. Even after two consecutive failures, the most recent literature data have demonstrated that H pylori eradication can be achieved in almost all patients, even when antibiotic susceptibility is not tested. Different possibilities of empirical treatment exist and the available third-line strategies are herein reviewed.

Nitrofuran‐based regimens for the eradication of Helicobacter pylori infection

“…[1][2][3]95 Here, quadruple therapy is recommended, although the second eradication may also fail in up to 30-40% of the cases as was shown by expert opinion, 96 a systematic review 97 and our own experience. 78 F-based second-line therapies obtained eradication rates as high as the primary regimens, suggesting that this compound could be usefully included in the second-line combinations.…”

“…One of the options could be an NF-or F-based quadruple combination as our results showed; the third-line eradication rates are, however, usually lower than the results of primary treatments. [1][2][3]96 Eradication of H. pylori is influenced by different factors. 4 The recommended duration of treatment is 7 days in Europe and Asia, 10 days in South America and 10-14 days in the USA.…”

Sitafloxacin resistance in Helicobacter pylori isolates and sitafloxacin-based triple therapy as a third-line regimen in Japan

“…Several studies have investigated the efficacy of candidate drugs for third-line therapy, including tetracycline, rifabutin and quinolones [3][4][5]. Levofloxacin (LVX) is the most commonly used quinolone for H. pylori eradication; its efficacy varies from 60% to 94% [5,6].…”

Quadruple Rescue erapy aer First and Second Line Failure for Helicobacter pylori Treatment: Comparison between Two Tetracycline-Based Regimens

“…In a recent meta-analysis, the mean percentage of success of a rifabutin-based triple therapy (rifabutin, amoxicillin and a proton pump inhibitor -PPI) was 66% when used in third line [6]. Tetracycline is a class of antibiotics that is largely used in second and third line therapy [7], usually in association with bismuth and metronidazole, the so called "quadruple therapy". However, in Italy the commercial package of tetracycline contains tablets with a dose of 250 mg. erefore, for an e ective treatment, the patient is requested to assume 8 pills/day of tetracycline in addition to the other drugs with a total number of 16 tablets/day for at least 10 days.…”