title: Efficacy of a triple therapy with rabeprazole, amoxicillin, and faropenem as second-line treatment after failure of initial Helicobacter pylori eradication therapy.
abstract: OBJECTIVE
  Triple therapy consisting of lansoprazole, amoxicillin, and clarithromycin (LAC regimen) is widely used to eradicate Helicobacter pylori in Japan. However, the need for appropriate treatment after failure of initial therapy to eradicate H. pylori has been increasing. We therefore assessed the efficacy of a combination of rabeprazole, amoxicillin, and faropenem for second-line eradication therapy.
  
  
  METHODS
  The subjects were 116 patients positive for H. pylori infection. Patients initially received lansoprazole 60 mg/day, amoxicillin 1500 mg/day and clarithromycin 400 mg/day in two divided doses for 7 days. Patients in whom eradication treatment failed were given rabeprazole 20 mg/day and amoxicillin 1500 mg/day in two divided doses, and faropenem 600 mg/day in three divided doses (RAF regimen) for 7 consecutive days. H. pylori status was assessed by the 13C-urea breath test combined with rapid urease test or H. pylori culture method 8 weeks after completion of therapy. Susceptibility to clarithromycin was determined by the agar dilution method, and genetic polymorphism of CYP2C19 was analyzed by polymerase chain reaction-restriction fragment length polymorphism.
  
  
  RESULTS
  The initial H. pylori eradication rate with the LAC regimen was 76.4% (84/110). Assessment of the CYP2C19 genotypes of the patients in whom eradication therapy failed revealed that homozygous extensive metabolizers accounted for 70.0% (16/23) and heterozygous extensive metabolizers for 30.0% (7/23), with no poor metabolizers. The acquired resistance rate for clarithromycin was 52.0% (12/23). The success rate of re-eradication with the RAF regimen was 91.3% (21/23) with no serious adverse effects.
  
  
  CONCLUSIONS
  Triple therapy comprising rabeprazole, amoxicillin, and faropenem is effective for second-line eradication treatment of H. pylori infection, regardless of the genetic polymorphism of CYP2C19 or the presence of resistance to clarithromycin.
authors.affiliation: Third Department of Internal Medicine, Yokohama City University School of Medicine, Yokohama, Japan. j_togawa@med.yokohama-cu.ac.jp
authors.forename: Jun-ichi
authors.initials: J
authors.lastname: Togawa
authors.forename: Masahiko
authors.initials: M
authors.lastname: Inamori
authors.forename: Nobutaka
authors.initials: N
authors.lastname: Fujisawa
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Takahashi
authors.forename: Masato
authors.initials: M
authors.lastname: Yoneda
authors.forename: Harunobu
authors.initials: H
authors.lastname: Kawamura
authors.forename: Yasunobu
authors.initials: Y
authors.lastname: Abe
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kirikoshi
authors.forename: Noritoshi
authors.initials: N
authors.lastname: Kobayashi
authors.forename: Takashi
authors.initials: T
authors.lastname: Sakaguchi
authors.forename: Tomoo
authors.initials: T
authors.lastname: Takamura
authors.forename: Atsushi
authors.initials: A
authors.lastname: Nakajima
authors.forename: Norio
authors.initials: N
authors.lastname: Ueno
authors.forename: Hisahiko
authors.initials: H
authors.lastname: Sekihara
mesh_terms: D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000658:Amoxicillin / Q000008:administration & dosage / Q000627:therapeutic use*; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001562:Benzimidazoles / Q000008:administration & dosage / Q000627:therapeutic use*; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D016481:Helicobacter Infections / Q000188:drug therapy*; D016480:Helicobacter pylori; D006801:Humans; D007769:Lactams / Q000008:administration & dosage / Q000627:therapeutic use*; D008875:Middle Aged; D009853:Omeprazole / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D064750:Rabeprazole; D019233:Retreatment; D016896:Treatment Outcome; D047090:beta-Lactams
chemical_list: D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000900:Anti-Bacterial Agents; D001562:Benzimidazoles; D007769:Lactams; D047090:beta-Lactams; D064750:Rabeprazole; D000658:Amoxicillin; C107057:fropenem; D009853:Omeprazole