title: 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.affiliation: Dept. of Medicine, Helsinki University Central Hospital, University of Helsinki, Finland.
authors.forename: K
authors.initials: K
authors.lastname: Seppälä
authors.forename: T U
authors.initials: TU
authors.lastname: Kosunen
authors.forename: H
authors.initials: H
authors.lastname: Nuutinen
authors.forename: P
authors.initials: P
authors.lastname: Sipponen
authors.forename: H
authors.initials: H
authors.lastname: Rautelin
authors.forename: S
authors.initials: S
authors.lastname: Sarna
authors.forename: H
authors.initials: H
authors.lastname: Hyvärinen
authors.forename: M
authors.initials: M
authors.lastname: Färkkilä
authors.forename: T A
authors.initials: TA
authors.lastname: Miettinen
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D017291:Clarithromycin / Q000627:therapeutic use; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D016481:Helicobacter Infections / Q000188:drug therapy*; D016480:Helicobacter pylori; D006801:Humans; D008297:Male; D008795:Metronidazole / Q000627:therapeutic use; D008875:Middle Aged; D009942:Organometallic Compounds / Q000627:therapeutic use; D011446:Prospective Studies; D054328:Proton Pump Inhibitors; D019233:Retreatment; D012189:Retrospective Studies; D013997:Time Factors; D017211:Treatment Failure
chemical_list: D000900:Anti-Bacterial Agents; D009942:Organometallic Compounds; D054328:Proton Pump Inhibitors; D008795:Metronidazole; D017291:Clarithromycin; C002791:bismuth tripotassium dicitrate