title: Second-line treatment for failure to eradicate Helicobacter pylori: a randomized trial comparing four treatment strategies.
abstract: OBJECTIVE
  To compare the efficacy of different regimens in patients in whom previous Helicobacter pylori eradication therapy has failed.
  
  
  METHODS
  In this study named StratHegy patients (n=287) were randomized to receive one of three empirical triple therapy regimens or a strategy based on antibiotic susceptibility. The empirical regimens were omeprazole, 20 mg b.d., plus amoxicillin, 1000 mg b.d., and clarithromycin, 500 mg b.d., for 7 days (OAC7), clarithromycin, 500 mg b.d., for 14 days (OAC14) or metronidazole, 500 mg b.d., for 14 days (OAM14). In the susceptibility-based strategy, patients with clarithromycin-susceptible strains received OAC14, whilst the others received OAM14. The 13C-urea breath test was performed before randomization and 4-5 weeks after eradication therapy.
  
  
  RESULTS
  In the intention-to-treat analysis, the eradication rates for empirical therapies were as follows: OAC7, 47.4% (27/57); OAC14, 34.5% (20/58); OAM14, 63.2% (36/57); it was 74.3% (84/113) for the susceptibility-based treatment (P<0.01 when compared with OAC7 and OAC14). In patients receiving clarithromycin, the eradication rates were 80% for clarithromycin-susceptible strains and 16% for clarithromycin-resistant strains; in patients receiving OAM14, the eradication rates were 81% for metronidazole-susceptible strains and 59% for metronidazole-resistant strains.
  
  
  CONCLUSIONS
  Eradication rates of approximately 75% can be achieved with second-line triple therapy based on antibiotic susceptibility testing. If susceptibility testing is not available, OAM14 is an appropriate alternative.
authors.affiliation: Service des Maladies de l' Appareil Digestif, Hôpital St André, Bordeaux, France.
authors.forename: H
authors.initials: H
authors.lastname: Lamouliatte
authors.forename: F
authors.initials: F
authors.lastname: Mégraud
authors.forename: J-C
authors.initials: JC
authors.lastname: Delchier
authors.forename: J-F
authors.initials: JF
authors.lastname: Bretagne
authors.forename: A
authors.initials: A
authors.lastname: Courillon-Mallet
authors.forename: J-D
authors.initials: JD
authors.lastname: De Korwin
authors.forename: J-L
authors.initials: JL
authors.lastname: Fauchère
authors.forename: A
authors.initials: A
authors.lastname: Labigne
authors.forename: J-F
authors.initials: JF
authors.lastname: Fléjou
authors.forename: P
authors.initials: P
authors.lastname: Barthelemy
mesh_terms: D000328:Adult; D000368:Aged; D000658:Amoxicillin / Q000008:administration & dosage / Q000009:adverse effects; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000009:adverse effects; D000897:Anti-Ulcer Agents / Q000008:administration & dosage* / Q000009:adverse effects; D001944:Breath Tests; D017291:Clarithromycin / Q000009:adverse effects / Q000627:therapeutic use; D004359:Drug Therapy, Combination / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D016481:Helicobacter Infections / Q000188:drug therapy*; D016480:Helicobacter pylori; D006801:Humans; D008297:Male; D008795:Metronidazole / Q000008:administration & dosage / Q000009:adverse effects; D008875:Middle Aged; D009853:Omeprazole / Q000008:administration & dosage* / Q000009:adverse effects; D017211:Treatment Failure
chemical_list: D000900:Anti-Bacterial Agents; D000897:Anti-Ulcer Agents; D008795:Metronidazole; D000658:Amoxicillin; D017291:Clarithromycin; D009853:Omeprazole