title: Effectiveness of two quadruple, tetracycline- or clarithromycin-containing, second-line, Helicobacter pylori eradication therapies.
abstract: BACKGROUND
  There are no guidelines on second-line therapies for Helicobacter pylori eradication failures of omeprazole-clarithromycin-amoxicillin triple therapy.
  
  
  OBJECTIVE
  To compare the efficacy of two second-line therapies for persistent H. pylori infection.
  
  
  METHODS
  Over a 6-year period, patients with persistent H. pylori infection following omeprazole-clarithromycin-amoxicillin eradication therapy were randomized to receive omeprazole, 20 mg twice daily, bismuth, 120 mg four times daily, metronidazole, 500 mg twice daily, and either tetracycline, 500 mg four times daily, or clarithromycin, 500 mg twice daily, given for 7 days. Before therapy, patients underwent endoscopy with biopsies for histology, culture and antibiotic susceptibility tests. H. pylori infection was confirmed by histology.
  
  
  RESULTS
  Of the 95 randomized patients, 88 (93%) completed the study. Age, sex, smoking, ulcer/non-ulcer dyspepsia ratio and antibiotic resistance were not significantly different between the treatment groups. On intention-to-treat analysis, eradication was achieved in 41 of the 49 patients (84%; 95% confidence interval, 70.4-92.7%) and 27 of the 46 patients (59%; 95% confidence interval, 43.3-73.0%) of the tetracycline- and clarithromycin-containing groups, respectively (P=0.007). On multivariate regression analysis, the sensitivity of H. pylori to metronidazole had a likelihood ratio of 5.2 (P=0.022), followed by the type of quadruple therapy (likelihood ratio, 4.4; P=0.036).
  
  
  CONCLUSIONS
  Tetracycline-containing quadruple rescue therapy is highly effective in treating H. pylori eradication failures of the omeprazole-amoxicillin-clarithromycin regimen.
authors.affiliation: Gastroenterology Unit, 2nd Department of Internal Medicine, Athens University, Evangelismos Hospital, Athens, Greece.
authors.forename: S D
authors.initials: SD
authors.lastname: Georgopoulos
authors.forename: S D
authors.initials: SD
authors.lastname: Ladas
authors.forename: S
authors.initials: S
authors.lastname: Karatapanis
authors.forename: K
authors.initials: K
authors.lastname: Triantafyllou
authors.forename: C
authors.initials: C
authors.lastname: Spiliadi
authors.forename: A
authors.initials: A
authors.lastname: Mentis
authors.forename: V
authors.initials: V
authors.lastname: Artikis
authors.forename: S A
authors.initials: SA
authors.lastname: Raptis
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000863:Antacids / Q000009:adverse effects / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001729:Bismuth / Q000009:adverse effects / Q000627:therapeutic use; D017291:Clarithromycin / Q000009:adverse effects / Q000627:therapeutic use*; D004347:Drug Interactions; D024881:Drug Resistance, Bacterial; D004359:Drug Therapy, Combination; D004415:Dyspepsia / Q000150:complications / Q000382:microbiology; D005260:Female; D016481:Helicobacter Infections / Q000150:complications / Q000188:drug therapy*; D016480:Helicobacter pylori / Q000302:isolation & purification / Q000502:physiology*; D006801:Humans; D008297:Male; D008795:Metronidazole / Q000009:adverse effects / Q000627:therapeutic use; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D015999:Multivariate Analysis; D009853:Omeprazole / Q000009:adverse effects / Q000627:therapeutic use; D013752:Tetracycline / Q000009:adverse effects / Q000627:therapeutic use*; D017211:Treatment Failure
chemical_list: D000863:Antacids; D000900:Anti-Bacterial Agents; D008795:Metronidazole; D013752:Tetracycline; D017291:Clarithromycin; D009853:Omeprazole; D001729:Bismuth