[Failure of Helicobacter pylori eradication--suggestions for further therapy].
Success of first H. pylori eradication attempts in the literature is around 80-90% and based on urea breath test of 1027 patients in Hungary is 75%. Repeated eradication attempts are needed in 10-25% of cases. In the clinical practice in Hungary second and third eradication attempts were successful only in 36% and 20% of cases. To improve efficacy the following suggestions has to be kept in mind: 1. Do not repeat the same combination if the first attempt is failed. 2. After failure of the first PPI + amoxicillin + clarithromycin triple therapy, either the quadriple therapy (PPI + tetracycline + metronidazole + bismuth) or the replacement of PPI with ranitidine bismuth citrate in the triple therapy is suggested. 3. If PPI + amoxicillin + metronidazole/tinidazole therapy fails, the metronidazole/tinidazole can be replaced by clarythromycin. 4. Do not start with clarithromycin + metronidazole/tinidazole therapy. 5. In case of uncertain previous therapies and for third eradication treatment send the patient to specialist. Rifabutin-based combinations seem to be effective, but the use of them in general practice is not advised due to the possible development of mycobacterium tuberculosis resistance.
Prónai
László
L
Semmelweis Egyetem, Altalános Orvostudományi Kar, II. sz. Belgyógyászati Klinika. pronai@bel2.sote.hu
Tulassay
Zsolt
Z
D017677:Age Distribution; D000658:Amoxicillin / Q000008:administration & dosage; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D017291:Clarithromycin / Q000008:administration & dosage; D024901:Drug Resistance, Multiple, Bacterial; D004359:Drug Therapy, Combination / Q000008:administration & dosage; D016481:Helicobacter Infections / Q000188:drug therapy* / Q000453:epidemiology; D016480:Helicobacter pylori / Q000187:drug effects*; D006801:Humans; D006814:Hungary / Q000453:epidemiology; D008795:Metronidazole / Q000008:administration & dosage; D009942:Organometallic Compounds / Q000008:administration & dosage; D011899:Ranitidine / Q000008:administration & dosage; D017828:Rifabutin / Q000008:administration & dosage; D014011:Tinidazole / Q000008:administration & dosage; D017211:Treatment Failure
D000900:Anti-Bacterial Agents; D009942:Organometallic Compounds; D014011:Tinidazole; D008795:Metronidazole; D017828:Rifabutin; D000658:Amoxicillin; D011899:Ranitidine; D017291:Clarithromycin; C002791:bismuth tripotassium dicitrate