title: Sequential therapy using high-dose esomeprazole-amoxicillin followed by gatifloxacin for Helicobacter pylori infection.
abstract: BACKGROUND
  The success rate of current anti-Helicobacter pylori triple therapies in now generally 80% or less. Sequential therapy has proved superior.
  
  
  OBJECTIVE
  To test a new sequential therapy for H. pylori eradication.
  
  
  METHODS
  This was a pilot study of a sequential therapy consisting of 40 mg of esomeprazole and 1 g amoxicillin t.d.s., for 12 days. On days 6 through 12 gatifloxacin (400 mg in the morning) was added. Outcome was accessed 4 or more weeks after ending antibiotic therapy. Both naive and treatment failures were eligible.
  
  
  RESULTS
  Thirty patients were entered in the study. One was lost to follow-up and one stopped early because of side effects. The success rate intention-to-treat was 80% (95% CI: 61-92%). The per-protocol eradication rate was 85.7% (95% CI: 67-95%); two of the four failures had pre-treatment gatifloxacin-resistant H. pylori. Side effects were reported by 13 patients (46%) and were generally mild with diarrhoea being most common (n = 6). Only one patient stopped medicine because of side effects of dizziness (severe) and diarrhoea (mild).
  
  
  CONCLUSIONS
  Sequential therapy using the combination of a high dose of proton-pump inhibitor and amoxicillin followed gatifloxacin was effective, but pre-treatment susceptibility testing may become necessary as fluoroquinolone resistance increases.
authors.affiliation: VAMC and Baylor College of Medicine, Houston, TX 77030, usa. dgraham@bcm.tmc.edu
authors.forename: D Y
authors.initials: DY
authors.lastname: Graham
authors.forename: S
authors.initials: S
authors.lastname: Abudayyeh
authors.forename: H M T
authors.initials: HM
authors.lastname: El-Zimaity
authors.forename: J
authors.initials: J
authors.lastname: Hoffman
authors.forename: R
authors.initials: R
authors.lastname: Reddy
authors.forename: A R
authors.initials: AR
authors.lastname: Opekun
mesh_terms: D000658:Amoxicillin / Q000008:administration & dosage* / Q000009:adverse effects; D000890:Anti-Infective Agents / Q000008:administration & dosage* / Q000009:adverse effects; D002985:Clinical Protocols; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D004791:Enzyme Inhibitors / Q000008:administration & dosage / Q000009:adverse effects; D064098:Esomeprazole / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D024841:Fluoroquinolones / Q000008:administration & dosage* / Q000009:adverse effects; D000077734:Gatifloxacin; D016481:Helicobacter Infections / Q000188:drug therapy*; D016480:Helicobacter pylori / Q000187:drug effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D000890:Anti-Infective Agents; D004791:Enzyme Inhibitors; D024841:Fluoroquinolones; D000658:Amoxicillin; D000077734:Gatifloxacin; D064098:Esomeprazole