A triple therapy regimen after failed Helicobacter pylori treatments.
BACKGROUND
Following standard triple therapy, up to 20% of patients require further Helicobacter pylori eradication treatment. Data regarding the efficacy of re-treatment in these patients are scarce.


OBJECTIVE
To evaluate the efficacy of a triple therapy after one or more consecutive treatment failures.


METHODS
A total of 51 patients with persistent H. pylori infection after at least one unsuccessful standard 1-week regimen were enrolled in the study. H. pylori infection at entry was assessed by rapid urease test and histology on biopsies from the antrum and the corpus. Patients were given a 2-week triple therapy, comprising ranitidine bismuth citrate 400 mg b.d., tetracycline 500 mg t.d.s., and tinidazole 500 mg b.d. Ranitidine bismuth citrate was given during meals, whilst tetracycline and tinidazole was given after meals. Bacterial eradication was assessed by endoscopy (36 patients) or 13C-urea breath test (15 patients) 4-6 weeks after therapy had ended.


RESULTS
All 51 patients completed the study and H. pylori eradication was achieved in 46, with an eradication rate of 90% (95% CI: 82-98). In detail, bacterial eradication was obtained in 96% of patients who had previously failed one course of clarithromycin-amoxicillin based triple therapy, in 88% patients who had failed a clarithromycin-tinidazole based triple therapy, in 83% patients who had failed both treatment schedules, and in the only patient who had failed three consecutive therapeutic attempts. Two patients took the therapy for 9 and 10 days instead of the full 14 day-course. No major side-effects were reported, whilst six (12%) patients complained of mild side-effects.


CONCLUSIONS
This study demonstrates that this triple therapy regimen is effective for re-treatment of H. pylori infection.
Zullo
A
A
Gastroenterology and Digestive Endoscopy, 'Nuovo Regina Margherita' Hospital, Rome, Italy. zullo@tiscalinet.it
Hassan
C
C
Campo
S M
SM
Lorenzetti
R
R
Febbraro
I
I
De Matthaeis
M
M
Porto
D
D
Morini
S
S
D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000897:Anti-Ulcer Agents / Q000627:therapeutic use*; D000994:Antitrichomonal Agents / Q000627:therapeutic use*; D001706:Biopsy; D001729:Bismuth / Q000627:therapeutic use*; D001944:Breath Tests; D002247:Carbon Isotopes; D004359:Drug Therapy, Combination; D016099:Endoscopy, Gastrointestinal; D005260:Female; D016481:Helicobacter Infections / Q000188:drug therapy* / Q000382:microbiology; D016480:Helicobacter pylori; D006801:Humans; D008297:Male; D008875:Middle Aged; D011899:Ranitidine / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D013752:Tetracycline / Q000627:therapeutic use*; D014011:Tinidazole / Q000627:therapeutic use*; D014508:Urea / Q000032:analysis / Q000097:blood; D014510:Urease / Q000096:biosynthesis
D000900:Anti-Bacterial Agents; D000897:Anti-Ulcer Agents; D000994:Antitrichomonal Agents; D002247:Carbon Isotopes; D014011:Tinidazole; C073340:ranitidine bismuth citrate; D011899:Ranitidine; D014508:Urea; D014510:Urease; D013752:Tetracycline; D001729:Bismuth