Several ‘rescue' therapies have been recommended to eradicate Helicobacter pylori.
However, they still fail in over 20% of the cases, and these patients constitute a therapeutic dilemma.
Dr Gisbert and colleagues from Spain prospectively evaluated the efficacy of different ‘rescue' therapies.
Empirically prescribed during 10 years to 500 patients in whom at least 1 eradication regimen had failed to cure H. pylori infection.
|Compliance rates with first-line regimens were 92%|
|Alimentary Pharmacology & Therapeutics|
Dr Gisbert and colleagues from Spain had a prospective single-center study.
The researchers examined consecutive patients in whom at least 1 eradication regimen had failed.
The team evaluated 4 rescue regimens, including quadruple therapy with omeprazole-bismuth-tetracycline-metronidazole.
The second assessed ranitidine bismuth citrate-tetracycline-metronidazole.
The third regimen evaluated omeprazole-amoxicillin-levofloxacin, and the final regimen included omeprazole-amoxicillin-rifabutin.
Antibiotic susceptibility was unknown.
The team found that eradication was defined as a negative 13C-urea breath test 4 to 8 weeks after completing therapy.
The researchers evaluated 500 patients, of which 76% had functional dyspepsia, and 24% peptic ulcer.
Compliance rates with first-, second- and third-line regimens were 92%, 92%, and 95%, respectively.
Adverse effects were reported by 30%, 37%, and 55% of the patients receiving second-, third-, and fourth-line regimens, respectively.
The team found that overall, H. pylori cure rates with the second-, third-, and fourth-line rescue regimens were 70%, 74%, and 76%, respectively.
Cumulative H. pylori eradication rate with 4 successive treatments was 100%.
Dr Gisberts' team concluded, "It is possible to construct an overall treatment strategy to maximize H. pylori eradication, on the basis of administration of 4 consecutive empirical regimens."
"Thus, performing bacterial culture even after a second or third eradication failure may not be necessary."