Salvage therapy after two or more prior Helicobacter pylori treatment failures: the super salvage regimen.
BACKGROUND
Although effective therapies are available for curing Helicobacter pylori infection, the problem persists about what to do for patients who fail two or more treatment courses despite a good compliance.


OBJECTIVE
To test a twice a day midday quadruple therapy as salvage therapy.


METHODS
Dyspeptic H. pylori-infected patients who failed two or more courses of anti-H. pylori therapy received omeprazole 20 mg, tetracycline 500 mg, metronidazole 500 mg, and bismuth subcitrate caplets 240 mg twice a day (with the midday and evening meals) for 14 days. H. pylori status was evaluated by 13C-urea breath test and histology 4-6 weeks after therapy. Eradication was defined as no positive test.


RESULTS
Seventy-one patients were enrolled and 68 completed the full 14 days of therapy (mean age 46 years; 28 men). Thirty-three patients had failed prior treatment twice, 19 had failed three times, and 16 had failed four or more times. The cure rates were: intention to treat=93% (66/71); (95% CI=84% to 98%), per protocol=97% (66/68); (95% CI=89%- 100%). Success was excellent irrespective of diagnosis, age, prior treatment protocols, or smoking status. Moderate side-effects were experienced by only two patients.


CONCLUSIONS
Midday bismuth subcitrate based twice a day quadruple therapy was an excellent salvage therapy. BID midday quadruple regimen should be considered as the therapy of choice.
Dore
Maria Pina
MP
Institute of Internal Medicine, University of Medicine, Sassari, Italy.
Marras
Lea
L
Maragkoudakis
Emmanouil
E
Nieddu
Salvatore
S
Manca
Alessandra
A
Graham
David Y
DY
Realdi
Giuseppe
G
D000328:Adult; D000863:Antacids / Q000009:adverse effects / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use*; D000890:Anti-Infective Agents / Q000009:adverse effects / Q000627:therapeutic use; D000897:Anti-Ulcer Agents / Q000009:adverse effects / Q000627:therapeutic use; D001729:Bismuth / Q000009:adverse effects / Q000627:therapeutic use; D001944:Breath Tests; D004359:Drug Therapy, Combination; D004415:Dyspepsia / Q000188:drug therapy / Q000382:microbiology; D005260:Female; D005753:Gastric Mucosa / Q000382:microbiology / Q000473:pathology; D016481:Helicobacter Infections / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008795:Metronidazole / Q000009:adverse effects / Q000627:therapeutic use*; D008875:Middle Aged; D009853:Omeprazole / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D009942:Organometallic Compounds / Q000009:adverse effects / Q000627:therapeutic use*; D016879:Salvage Therapy; D013754:Tetracyclines; D014508:Urea / Q000032:analysis / Q000378:metabolism
D000863:Antacids; D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents; D000897:Anti-Ulcer Agents; D009942:Organometallic Compounds; D013754:Tetracyclines; D008795:Metronidazole; D014508:Urea; C002791:bismuth tripotassium dicitrate; D009853:Omeprazole; D001729:Bismuth