Treatment of helicobacter pylori eradication failures

Abstract

Even with the current most effective treatment regimens, about 10% to 20% of patients will fail to eradicate Helicobacter pylori infection. Therefore, in designing a treatment strategy, we should not focus on the results of primary therapy alone but also on the final (overall) eradication rate. The choice of a second-line treatment depends on which treatment was used initially, because retreatment with the same regimen is not recommended. Therefore, it seems that performing culture after a first eradication failure is not necessary and assessing H. pylori sensitivity to antibiotics only after failure of the second treatment is suggested in clinical practice. Different possibilities of empirical treatment are suggested. After failure of proton pump inhibitor (PPI)-amoxicillin-clarithromycin, quadruple therapy has been generally used. More recently, replacing the PPI and the bismuth compound by ranitidine bismuth citrate has also achieved good results. After PPI-amoxicillin-nitroimidazole failure, retreatment with PPI-amoxicillin-clarithromycin has proved to be effective. Finally, the first therapy should not combine clarithromycin and metronidazole in the same regimen because of the problem of resistance against both antibiotics. Recently, rifabutin-based rescue therapies have been shown to constitute an encouraging strategy for eradication failures because they are effective for H. pylori strains resistant to antibiotics.

Comparison of Two Management Strategies for Helicobacter pylori Treatment: Clinical Study and Cost‐effectiveness Analysis

“…triple first plus quadruple second-line), [13] the use of triple therapy after quadruple-therapy failure seems the most sensible approach. Since triple therapy including amoxicillin and clarithromycin has proved its efficacy and does not include metronidazole or tetracycline (the antibiotics used in quadruple therapy), and because there is extensive evidence of the efficacy of the reverse strategy (i.e.…”

“…The 'quadruple-first' strategy branch is identical apart from the changing of the places of OCA and OBTM 13. The 'quadruple-first' strategy branch is identical apart from the changing of the places of OCA and OBTM 13.…”

“…A therapeutic strategy for H. pylori eradication should combine an effective first-line schedule with a second-line treatment with proven efficacy even if secondary antibiotic resistance arises [12]. Few randomized trials have compared the efficacy of second-line therapies, but many nonrandomized studies suggest that quadruple therapy is effective after triple therapy combining a proton pump inhibitor, clarithromycin and amoxicillin [13].…”

“…Since triple therapy including amoxicillin and clarithromycin has proved its efficacy and does not include metronidazole or tetracycline (the antibiotics used in quadruple therapy), and because there is extensive evidence of the efficacy of the reverse strategy (i.e. triple first plus quadruple second-line), [13] the use of triple therapy after quadruple-therapy failure seems the most sensible approach. To our knowledge, only one small randomized trial has so far addressed the issue from the perspectives of efficacy and economic cost [7].…”

The Bitterness Intensity of Clarithromycin Evaluated by a Taste Sensor

“…The macrolide clarithromycin is active against penicillinsusceptible and penicillin-intermediate pneumococci, as well as Moraxella catarrhalis, and is used to treat various diseases, especially Helicobacter pylori 1) and pediatric infections.…”