title: Multiple-antibiotic-resistant Helicobacter pylori infection eradicated with a tailor-made quadruple therapy.
abstract: In 2008, a 44-year-old woman with mild epigastralgia diagnosed as having Helicobacter pylori-positive chronic gastritis without peptic ulcer underwent eradication therapy with lansoprazole (LPZ), amoxicillin (AMPC) and clarithromycin (CAM) for 7 days, but it failed, so treatment with rabeprazole, AMPC, and metronidazole (MNZ) for another 7 days was given, but it also failed. She was then prescribed a modified, 14-day sequential therapy of LPZ and AMPC with an increased dose of CAM followed by MNZ supplement, but the infection was still not eradicated. The H. pylori was cultured and examined for antibiotic susceptibility with the agar dilution method and was found to be resistant to CAM, MNZ, and levofloxacin, and non-sensitive to AMPC, namely multiple-antibiotic-resistant, although sensitive to minocycline. The CYP2C19 genotype of the patient was an extensive metabolizer (G681A: G/A, G636A: G/G). In 2010, she gave informed consent for a 14-day, tailor-made, modified classical (or modified high-dose PPI + AMPC) quadruple therapy comprising 30 mg LPZ, 500 mg AMPC and 500 mg bismuth subnitrate, qid, and 100 mg minocycline, bid. Two months later, her urea breath test was negative. Histology and bacterial culture were still negative 1 year after the therapy. She did not have any adverse events during or after the novel therapy, nor did she feel any further epigastralgia.
authors.affiliation: Department of Medicine, Gastroenterology, Healthcare, Social Insurance Shiga Hospital, Otsu, Shiga, Japan. shigemin@rainbow.plala.or.jp
authors.forename: Shigemi
authors.initials: S
authors.lastname: Nakajima
authors.forename: Hisayuki
authors.initials: H
authors.lastname: Inoue
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Inoue
authors.forename: Yuri
authors.initials: Y
authors.lastname: Maruoka
mesh_terms: D053799:2-Pyridinylmethylsulfinylbenzimidazoles / Q000008:administration & dosage; D000328:Adult; D000658:Amoxicillin / Q000008:administration & dosage; D000863:Antacids / Q000008:administration & dosage* / Q000378:metabolism; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000378:metabolism; D001189:Aryl Hydrocarbon Hydroxylases / Q000235:genetics / Q000378:metabolism; D001729:Bismuth / Q000008:administration & dosage; D001944:Breath Tests; D065731:Cytochrome P-450 CYP2C19; D004334:Drug Administration Schedule; D024901:Drug Resistance, Multiple, Bacterial; D004359:Drug Therapy, Combination; D005260:Female; D005756:Gastritis / Q000175:diagnosis / Q000188:drug therapy* / Q000235:genetics / Q000382:microbiology; D005838:Genotype; D016481:Helicobacter Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000235:genetics / Q000382:microbiology; D016480:Helicobacter pylori / Q000187:drug effects* / Q000472:pathogenicity; D006801:Humans; D064747:Lansoprazole; D008826:Microbial Sensitivity Tests; D008911:Minocycline / Q000008:administration & dosage; D010641:Phenotype; D054328:Proton Pump Inhibitors / Q000008:administration & dosage* / Q000378:metabolism; D013997:Time Factors
chemical_list: D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000863:Antacids; D000900:Anti-Bacterial Agents; D054328:Proton Pump Inhibitors; D064747:Lansoprazole; D000658:Amoxicillin; D001189:Aryl Hydrocarbon Hydroxylases; C045793:CYP2C19 protein, human; D065731:Cytochrome P-450 CYP2C19; D008911:Minocycline; C010804:bismuth subnitrate; D001729:Bismuth