Cure of Helicobacter pylori infection after failed primary treatment: one-center results from 120 patients.

Abstract

BACKGROUND:

Treatment with a proton pump inhibitor (PPI) and antimicrobials cures Helicobacter pylori infection in about 90% of patients. This is a retrospective overview of our studies aiming to cure the infection in all compliant patients with failed initial therapy.

METHODS:

We retreated 120 (19% of 644) H. pylori-infected patients whose initial therapy had failed. The retreatments included (i) triple therapy (TT): colloidal bismuth subcitrate, metronidazole, amoxicillin (or tetracycline); (ii) quadruple therapy (QT): TT and a PPI; or (iii) high doses of both a PPI and clarithromycin combined with a further 1-3 individually selected antimicrobials. The eradication results were determined after 6-12 months.

RESULTS:

The 1st retreatment was successful in 70 of 120 patients. The 2nd retreatment cured 25 of the remaining 42 patients, the 3rd 13 of 17, and the 4th the last 4 patients. The cumulative eradication rate (ITT) was 93% (95% CI: 88.9%-97.9%; 8 patients withdrew after a failed 1st retreatment) and the rate was 100% in the remaining 112 patients who accepted several retreatments. The 1st retreatment with TT cured 23% (95% CI: 12%-34%) of 57 patients and QT 85% (95% CI: 74%-96%) of 41 patients who had initially undergone a failed metronidazole-based treatment. All retreatments were well tolerated.

CONCLUSIONS:

In this study, high doses of a PPI and clarithromycin combined with 1-3 antimicrobials according to susceptibility data proved to be the best drug combination in the cure of H. pylori infection after failed primary treatment. Giving imidazole- and bismuth-based QT (without clarithromycin) as the first-line treatment of H. pylori infection ensures that the number of failures remains low.

• Authors: K Seppälä, T U Kosunen, H Nuutinen, P Sipponen, H Rautelin, S Sarna, H Hyvärinen, M Färkkilä, T A Miettinen
• Journal: Scandinavian journal of gastroenterology (Scand J Gastroenterol) Vol. 35 Issue 9 Pg. 929-34 (Sep 2000) ISSN: 0036-5521 [Print] England
• PMID: 11063151 (Publication Type: Journal Article)

Chemical References

• Anti-Bacterial Agents
• Organometallic Compounds
• Proton Pump Inhibitors
• Metronidazole
• Clarithromycin
• bismuth tripotassium dicitrate

Topics

• Anti-Bacterial Agents (therapeutic use)
• Clarithromycin (therapeutic use)
• Drug Therapy, Combination (therapeutic use)
• Female
• Follow-Up Studies
• Helicobacter Infections (drug therapy)
• Helicobacter pylori
• Humans
• Male
• Metronidazole (therapeutic use)
• Middle Aged
• Organometallic Compounds (therapeutic use)
• Prospective Studies
• Proton Pump Inhibitors
• Retreatment
• Retrospective Studies
• Time Factors
• Treatment Failure