title: Third line treatment for Helicobacter pylori: a prospective, culture-guided study in peptic ulcer patients.
abstract: BACKGROUND
  A third line treatment is needed in roughly 5% of patients infected with Helicobacter pylori. Few data have been reported on efficacy of treatment regimens in these patients.
  
  
  METHODS
  A prospective trial was designed to study the effectiveness of third line treatment of H. pylori infection in ulcer patients. Two-week quadruple, culture-guided, combinations were used in 31 consecutive patients. Susceptibility to metronidazole and clarithromycin were studied by E-test, and thereafter a predetermined treatment regimen was used. Compliance was evaluated by pill count, and eradication defined by negative urea breath test at 6 weeks.
  
  
  RESULTS
  Two main quadruple regimens were used in 29 patients. In spite of good compliance, the combination of omeprazole, tetracycline, bismuth and clarithromycin (OTBC) showed an eradication rate (per protocol analysis) of 36% (five out of 14; CI: 12.8-64.9), and if amoxycillin was used (OTBA) the rate was 67% (eight out of 12; CI: 34.9-90.1). The difference was not significant. No clinical factor was found to be associated with failure to eradicate.
  
  
  CONCLUSIONS
  Third line treatment often fails to eradicate H. pylori infection. New strategies need to be developed and tested for this common clinical situation.
authors.affiliation: Digestive Disease Service, Hospital Universitario Miguel Servet, Zaragoza, Spain. fgomollon@ingenia.es
authors.forename: F
authors.initials: F
authors.lastname: Gomollón
authors.forename: B
authors.initials: B
authors.lastname: Sicilia
authors.forename: J A
authors.initials: JA
authors.lastname: Ducóns
authors.forename: E
authors.initials: E
authors.lastname: Sierra
authors.forename: M J
authors.initials: MJ
authors.lastname: Revillo
authors.forename: M
authors.initials: M
authors.lastname: Ferrero
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001944:Breath Tests; D017291:Clarithromycin / Q000627:therapeutic use; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D016481:Helicobacter Infections / Q000150:complications / Q000188:drug therapy* / Q000382:microbiology*; D016480:Helicobacter pylori; D006801:Humans; D008297:Male; D008795:Metronidazole / Q000627:therapeutic use; D008875:Middle Aged; D010349:Patient Compliance; D010437:Peptic Ulcer / Q000150:complications / Q000188:drug therapy* / Q000382:microbiology*; D011446:Prospective Studies; D014508:Urea / Q000378:metabolism
chemical_list: D000900:Anti-Bacterial Agents; D008795:Metronidazole; D014508:Urea; D017291:Clarithromycin