title: High efficacy of 1-week doxycycline- and amoxicillin-based quadruple regimen in a culture-guided, third-line treatment approach for Helicobacter pylori infection.
abstract: BACKGROUND
  Helicobacter pylori infection may persist after both first- and second-line current treatments.
  
  
  OBJECTIVE
  To assess the efficacy of a third-line, culture-guided treatment approach for the eradication of H. pylori.
  
  
  METHODS
  Patterns of resistance were analysed in H. pylori isolates from 94 consecutive patients in whom H. pylori infection had persisted after two eradication attempts. Using the epsilometer test, susceptibility analysis was performed for amoxicillin, clarithromycin, metronidazole, tetracycline and levofloxacin. Patients were then treated with a culture-guided, third-line regimen: 89 patients with a 1-week quadruple regimen including omeprazole, bismuth, doxycycline and amoxicillin, and five patients with a 1-week triple regimen containing omeprazole, amoxicillin and levofloxacin or clarithromycin.
  
  
  RESULTS
  Ninety-four subjects (100%) were resistant to metronidazole, 89 (95%) to clarithromycin, 29 (31%) to levofloxacin and five (5%) to tetracycline. No resistance to amoxicillin was found in any patient. Overall, H. pylori eradication was obtained in 90% of subjects. The quadruple regimen was effective in 81 patients (92% by per protocol and 91% by intention-to-treat analysis). Four patients (80%, both per protocol and intention-to-treat analysis) were H. pylori-negative after the triple regimen.
  
  
  CONCLUSIONS
  A culture-guided, third-line therapeutic approach is effective for the eradication of H. pylori. Furthermore, the 1-week doxycycline- and amoxicillin-based quadruple regimen is a good third-line 'rescue' treatment option.
authors.affiliation: Department of Internal Medicine and Gastroenterology, Catholic University of Rome, Rome, Italy. gcammarota@rm.unicatt.it
authors.forename: G
authors.initials: G
authors.lastname: Cammarota
authors.forename: A
authors.initials: A
authors.lastname: Martino
authors.forename: G
authors.initials: G
authors.lastname: Pirozzi
authors.forename: R
authors.initials: R
authors.lastname: Cianci
authors.forename: G
authors.initials: G
authors.lastname: Branca
authors.forename: E C
authors.initials: EC
authors.lastname: Nista
authors.forename: A
authors.initials: A
authors.lastname: Cazzato
authors.forename: O
authors.initials: O
authors.lastname: Cannizzaro
authors.forename: L
authors.initials: L
authors.lastname: Miele
authors.forename: A
authors.initials: A
authors.lastname: Grieco
authors.forename: A
authors.initials: A
authors.lastname: Gasbarrini
authors.forename: G
authors.initials: G
authors.lastname: Gasbarrini
mesh_terms: D000658:Amoxicillin; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D004318:Doxycycline; D024881:Drug Resistance, Bacterial; D004359:Drug Therapy, Combination / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D016481:Helicobacter Infections / Q000188:drug therapy*; D016480:Helicobacter pylori; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance
chemical_list: D000900:Anti-Bacterial Agents; D000658:Amoxicillin; D004318:Doxycycline