title: Helicobacter pylori first-line treatment and rescue options in patients allergic to penicillin.
abstract: BACKGROUND
  Helicobacter pylori eradication is a challenge in patients allergic to penicillin, especially those who have failed a first-eradication trial.
  
  
  OBJECTIVE
  To assess the efficacy and tolerability of H. pylori first-line treatment and rescue options in patients allergic to penicillin.
  
  
  METHODS
  Prospective single centre study including 40 consecutive treatments administered to patients allergic to penicillin. Therapy regimens: First-line (12 patients) omeprazole, clarithromycin and metronidazole for 7 days; second-line (17 patients) ranitidine bismuth citrate, tetracycline and metronidazole for 7 days; third-line (nine patients) rifabutin, clarithromycin and omeprazole for 10 days; and fourth-line (two patients) levofloxacin, clarithromycin and omeprazole for 10 days.
  
  
  METHODS
  a negative (13)C-urea breath test 8 weeks after completion of treatment.
  
  
  RESULTS
  Per-protocol/intention-to-treat eradication rates were: first-line (64/58%); second-line (ranitidine bismuth citrate; 53/47%); third-line (rifabutin; 17/11%) and fourth-line regimen (levofloxacin; 100/100%). Compliance with treatment was generally good, except with the rifabutin-based regimen, which presented adverse effects in 89% of the patients, including four cases of myelotoxicity.
  
  
  CONCLUSIONS
  H. pylori-infected patients who are allergic to penicillin may be treated with a first-line treatment combining a proton-pump inhibitor, clarithromycin and metronidazole. Rescue options may include a regimen with ranitidine bismuth citrate, tetracycline and metronidazole. A levofloxacin-based rescue regimen (with proton-pump inhibitor and clarithromycin) may also represent an alternative, even when two or more consecutive eradication treatments have previously failed. However, rifabutin + clarithromycin + proton-pump inhibitor regimen is ineffective and poorly tolerated.
authors.affiliation: Department of Gastroenterology, La Princesa University Hospital, Madrid, Spain. gisbert@meditex.es
authors.forename: J P
authors.initials: JP
authors.lastname: Gisbert
authors.forename: J L
authors.initials: JL
authors.lastname: Gisbert
authors.forename: S
authors.initials: S
authors.lastname: Marcos
authors.forename: D
authors.initials: D
authors.lastname: Olivares
authors.forename: J M
authors.initials: JM
authors.lastname: Pajares
mesh_terms: 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*; D004342:Drug Hypersensitivity / Q000150:complications*; D024881:Drug Resistance, Bacterial; D004359:Drug Therapy, Combination; D005260:Female; D016481:Helicobacter Infections / Q000150:complications / Q000188:drug therapy*; D016480:Helicobacter pylori; D006801:Humans; D008297:Male; D008875:Middle Aged; D010406:Penicillins / Q000009:adverse effects*; D011446:Prospective Studies
chemical_list: D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents; D000897:Anti-Ulcer Agents; D010406:Penicillins