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- Title
Quadruple Rescue Therapy after First and Second Line Failure for Helicobacter pylori Treatment: Comparison between Two Tetracycline-Based Regimens.
- Authors
Ierardi, Enzo; Giangaspero, Antonio; Losurdo, Giuseppe; Giorgio, Floriana; Amoruso, Annacinzia; Francesco, Vincenzo De; Leo, Alfredo Di; Principi, Mariabeatrice
- Abstract
Background & Aims: Antibiotic resistance is the main reason for failure of Helicobacter pylori (H. pylori) treatment. Currently, guidelines recommend a treatment guided by antimicrobial susceptibility testing after two failures. However, microbial culture is not feasible everywhere, and the limited number of effective antibiotics against the bacterium narrows the options; thus a rescue therapy combining antibiotics with a low resistance may be fitting. Methods: Patients who have failed a first-line treatment (either prolonged triple or sequential regimens) and, successively, a levofloxacin-based triple therapy were considered for the study. Subjects underwent urea breath test (UBT), stool antigen test (ST) and endoscopy/histology to confirm the diagnosis. Cytopenia and impaired liver and kidney function were exclusion criteria. Fifty-four subjects were randomized 1:1 to two regimens: RMB Rabeprazole/Rifabutin/Minocycline/Bismuth sub-citrate or MTB Rabeprazole/Tinidazole/ Minocycline/Bismuth sub-citrate both for 10 days. The results were checked 6 weeks after the end of therapy with ST/UBT plus endoscopy when indicated. Results: RMB eradicated the bacterium in 21 patients. Two subjects dropped out. The eradication rate was 77.7% (Cl 62.0-93.4%) at intention-to-treat and 84.0% (Cl 69.6-98.4%) at per-protocol analysis. MTB was successful in 14 patients (51.9%, Cl 33.1-70.7%). No patient withdrew from the treatment for adverse events. Drug-related side effects were reported only in 3 subjects, but in all cases the treatment was carried on. Conclusions: The association minocycline/rifabutin seems to have a synergic effect and a good therapeutic outcome in patients who have failed at least two previous regimens, although a trial on a large population is needed.
- Subjects
HELICOBACTER; TETRACYCLINES; ANTIBIOTIC residues; ANTIGEN receptors
- Publication
Journal of Gastrointestinal & Liver Diseases, 2014, Vol 23, Issue 4, p367
- ISSN
1841-8724
- Publication type
Article
- DOI
10.15403/jgld.2014.1121.234.qrth