title: Salvage therapy after two or more prior Helicobacter pylori treatment failures: the super salvage regimen.
abstract: 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.
authors.affiliation: Institute of Internal Medicine, University of Medicine, Sassari, Italy.
authors.forename: Maria Pina
authors.initials: MP
authors.lastname: Dore
authors.forename: Lea
authors.initials: L
authors.lastname: Marras
authors.forename: Emmanouil
authors.initials: E
authors.lastname: Maragkoudakis
authors.forename: Salvatore
authors.initials: S
authors.lastname: Nieddu
authors.forename: Alessandra
authors.initials: A
authors.lastname: Manca
authors.forename: David Y
authors.initials: DY
authors.lastname: Graham
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Realdi
mesh_terms: 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
chemical_list: 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