Efficacy of quadruple therapy with pantoprazole, bismuth, tetracycline and metronidazole as rescue treatment for Helicobacter pylori infection.
OBJECTIVE
To study the efficacy of a 7-day quadruple regimen combining pantoprazole, bismuth, tetracycline and metronidazole as rescue treatment for Helicobacter pylori infection after failure of standard triple therapy.


METHODS
A prospective study was made of 140 patients infected with H. pylori and diagnosed with peptic ulcer or non-ulcer dyspepsia in whom triple therapy with proton pump inhibitor, clarithromycin and amoxicillin had failed. The patients were treated with quadruple therapy including pantoprazole, 40 mg twice daily, colloidal bismuth subcitrate, 120 mg four times daily, tetracycline, 500 mg four times daily, and metronidazole, 500 mg three times daily, for 7 days. Two months after completion of therapy, a 13C-urea breath test was performed to confirm eradication.


RESULTS
With quadruple therapy, the H. pylori eradication rates were 82% (95% confidence interval (CI), 75-88%) by 'intention-to-treat' and 85% (95% CI, 79-91%) by 'per protocol'. No major side-effects were observed. No differences in eradication success were observed in relation to underlying disease (peptic ulcer: 85% (95% CI, 76-91%) vs. non-ulcer dyspepsia: 83% (95% CI, 68-93%)) or smoking habits (smokers: 86% (95% CI, 75-93%) vs. non-smokers: 83% (95% CI, 71-91%)).


CONCLUSIONS
Quadruple therapy with pantoprazole, bismuth, tetracycline and metronidazole for 7 days is an effective H. pylori eradication treatment for patients in whom standard triple therapy has failed.
Department of Gastroenterology, Ramón y Cajal Hospital, University of Alcalá, Madrid, Spain.
D
D
Boixeda
F
F
Bermejo
C
C
Martín-De-Argila
A
A
López-Sanromán
V
V
Defarges
F
F
Hernández-Ranz
J M
JM
Milicua
A
A
García-Plaza
D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000897:Anti-Ulcer Agents / Q000627:therapeutic use*; D001562:Benzimidazoles / Q000627:therapeutic use; D001729:Bismuth / Q000627:therapeutic use; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D004415:Dyspepsia / Q000382:microbiology; D005260:Female; D016481:Helicobacter Infections / Q000150:complications / Q000188:drug therapy*; D016480:Helicobacter pylori; D006801:Humans; D008297:Male; D008795:Metronidazole / Q000627:therapeutic use; D008875:Middle Aged; D009853:Omeprazole / Q000031:analogs & derivatives; D009942:Organometallic Compounds / Q000627:therapeutic use; D000077402:Pantoprazole; D010437:Peptic Ulcer / Q000382:microbiology; D011446:Prospective Studies; D013454:Sulfoxides / Q000627:therapeutic use; D013752:Tetracycline / Q000627:therapeutic use; D017211:Treatment Failure; D016896:Treatment Outcome
D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000900:Anti-Bacterial Agents; D000897:Anti-Ulcer Agents; D001562:Benzimidazoles; D009942:Organometallic Compounds; D013454:Sulfoxides; D008795:Metronidazole; D000077402:Pantoprazole; D013752:Tetracycline; C002791:bismuth tripotassium dicitrate; D009853:Omeprazole; D001729:Bismuth