title: Comparison of three different second-line quadruple therapies including bismuth subcitrate in Turkish patients with non-ulcer dyspepsia who failed to eradicate Helicobacter pylori with a 14-day standard first-line therapy.
abstract: OBJECTIVE
  Many studies have reported poor results with standard first-line treatment for Helicobacter pylori. Second-line regimens that may overcome bacterial resistance can minimize side-effects and optimize compliance. The aim of this study was to evaluate the efficacy of proton pump inhibitor (PPI) and bismuth subcitrate-based quadruple therapy, after failure of a PPI plus clarithromycin and amoxicillin as first-line therapy.
  
  
  METHODS
  Patients who failed to eradicate the infection after initial therapy were randomly separated into three groups. The first group received lansoprazole, bismuth subcitrate, metronidazole and amoxicillin (LBMA); in the second group metronidazole was replaced by tetracycline (LBTA); and the third group was given metronidazole and tetracycline in addition to same doses of lansoprazole and bismuth subcitrate (LBMT).
  
  
  RESULTS
  In the LBMA group, the eradication rate was 74.7% and was significantly related to sex, with no relationship to age. In the LBTA group the eradication rate was 81.5% with similar rates in males and females. No relation to sex or age was observed. In the LBMT group the eradication rate was 82.1% with no difference between women and men and it was not related to age, either. Eradication rates in study groups were similar (P > 0.05).
  
  
  CONCLUSIONS
  A-14-day regimen of lansoprazole, bismuth subcitrate and antibiotic pairs, tetracycline-amoxicillin and tetracycline-metronidazole, is an effective quadruple therapy after one failed course of standard triple therapy. The evaluation of tolerability of and compliance with quadruple therapy needs further studies.
authors.affiliation: Department of Gastroenterology, Gulhane Military Medical Academy, School of Medicine, Ankara, Turkey.
authors.forename: Ahmet
authors.initials: A
authors.lastname: Uygun
authors.forename: A Melih
authors.initials: AM
authors.lastname: Ozel
authors.forename: Oguzhan
authors.initials: O
authors.lastname: Yildiz
authors.forename: Murat
authors.initials: M
authors.lastname: Aslan
authors.forename: Zeki
authors.initials: Z
authors.lastname: Yesilova
authors.forename: Ahmet
authors.initials: A
authors.lastname: Erdil
authors.forename: Sait
authors.initials: S
authors.lastname: Bagci
authors.forename: Omer
authors.initials: O
authors.lastname: Gunhan
mesh_terms: D053799:2-Pyridinylmethylsulfinylbenzimidazoles / Q000627:therapeutic use; D000328:Adult; D000658:Amoxicillin / Q000627:therapeutic use; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D004415:Dyspepsia / Q000188:drug therapy / Q000382:microbiology*; D005260:Female; D016481:Helicobacter Infections / Q000150:complications / Q000188:drug therapy*; D016480:Helicobacter pylori; D006801:Humans; D064747:Lansoprazole; D008297:Male; D008795:Metronidazole / Q000627:therapeutic use; D008875:Middle Aged; D009942:Organometallic Compounds / Q000627:therapeutic use*; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*; D013752:Tetracycline / Q000627:therapeutic use; D017211:Treatment Failure; D016896:Treatment Outcome; D014421:Turkey
chemical_list: D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000890:Anti-Infective Agents; D009942:Organometallic Compounds; D054328:Proton Pump Inhibitors; D064747:Lansoprazole; D008795:Metronidazole; D000658:Amoxicillin; D013752:Tetracycline; C002791:bismuth tripotassium dicitrate