title: Salvage therapies after failure of Helicobacter pylori eradication with ranitidine bismuth citrate-based therapies.
abstract: BACKGROUND
  Salvage therapies after initial Helicobacter pylori eradication failure of ranitidine bismuth citrate (RBC)-based regimens remain undefined.
  
  
  OBJECTIVE
  To test the efficacy of 1-week omeprazole, amoxycillin and clarithromycin as a second-line treatment and 1-week quadruple therapy after repeated failures of RBC- and proton pump inhibitor-based regimens.
  
  
  METHODS
  Patients were recruited from a recently published prospective randomized study if confirmed to have failed H. pylori eradication with RBC-based regimens. They were given omeprazole 20 mg, amoxycillin 1 g and clarithromycin 500 mg (OAC) b.d. for 1 week. 13C-urea breath test was performed 4 weeks after the conclusion of medication. Those who failed to respond to OAC were given 1-week quadruple therapy (bismuth subcitrate 120 mg, tetracycline 500 mg and metronidazole 400 mg q.d.s. plus omeprazole 20 mg b.d.).
  
  
  RESULTS
  Among 398 patients receiving RBC-based therapies, 40 (10%) had failed eradication (RAC=7, RC-2=12, RMC=7, and RMT=14). OAC was prescribed to 31 patients (RAC=4, RC-2=9, RMC=6, and RMT=12) and 68% had successful eradication. Nine out of 10 patients with failed second treatment received quadruple therapy; successful eradication occurred in 83% (5 out of 6) after repeated failures of clarithromycin-based regimens.
  
  
  CONCLUSIONS
  One-week OAC is not an optimal second-line therapy when RBC-clarithromycin combinations fail. Quadruple therapy appears to be effective despite repeated failures of clarithromycin-based RBC or proton pump inhibitor therapies.
authors.affiliation: Department of Medicine & Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong. fklchan@cuhk.edu.hk
authors.forename: F K
authors.initials: FK
authors.lastname: Chan
authors.forename: J J
authors.initials: JJ
authors.lastname: Sung
authors.forename: R
authors.initials: R
authors.lastname: Suen
authors.forename: J C
authors.initials: JC
authors.lastname: Wu
authors.forename: T K
authors.initials: TK
authors.lastname: Ling
authors.forename: S C
authors.initials: SC
authors.lastname: Chung
mesh_terms: D000658:Amoxicillin / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000897:Anti-Ulcer Agents / Q000627:therapeutic use*; D001729:Bismuth / Q000627:therapeutic use*; D017291:Clarithromycin / Q000627:therapeutic use; D004791:Enzyme Inhibitors / Q000627:therapeutic use; D016481:Helicobacter Infections / Q000188:drug therapy* / Q000382:microbiology; D016480:Helicobacter pylori; D006801:Humans; D009853:Omeprazole / Q000627:therapeutic use; D010406:Penicillins / Q000627:therapeutic use; D011446:Prospective Studies; D054328:Proton Pump Inhibitors; D011899:Ranitidine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D016879:Salvage Therapy
chemical_list: D000900:Anti-Bacterial Agents; D000897:Anti-Ulcer Agents; D004791:Enzyme Inhibitors; D010406:Penicillins; D054328:Proton Pump Inhibitors; C073340:ranitidine bismuth citrate; D000658:Amoxicillin; D011899:Ranitidine; D017291:Clarithromycin; D009853:Omeprazole; D001729:Bismuth