BACKGROUND The eradication of Helicobacter pylori
infection, commonly prevailing in the stomach, has been important since its introduction. Adequate preparations should be made in finding alternatives when faced with first-line treatment failures. Currently, ideal second-line treatments are indistinct and varied among countries as result of different antibiotic resistance patterns. We aimed to evaluate the safety and efficacy of a
clarithromycin-containing
bismuth-based quadruple regimen as a second-line treatment. METHODS Forty-eight H.pylori-positive patients with proven gastric or
duodenal ulcers and/or erosions who had previously failed to respond to
furazolidone-containing regimens were enrolled. They received
pantoprazole (40 mg-bid),
amoxicillin (1gr-bid),
bismuth subcitrate (240 mg-bid), and
clarithromycin (500mg-bid) for 10 days. Eight weeks
after treatment, a (14)C-urea breath test was performed for the re-evaluation of H. pylori eradication. RESULTS Forty-three patients completed the study. H.pylori eradication rates were 79.2% (95% CI=65.00-89.53) and 88.4% (95% CI=74.91-96.11) according to intention-to-treat and per-protocol analyses, respectively. All patients had excellent compliance to treatment and one did not continue
therapy because of adverse effects. CONCLUSION In developing countries such as Iran, a ten-day
clarithromycin-containing
bismuth-based quadruple regimen is encouraged as a second-line treatment because of the acceptable rate of eradication and low adverse effects.