Dual therapy for third-line Helicobacter pylori eradication and urea breath test prediction.
We evaluated the efficacy and tolerability of a dual therapy with rabeprazole and amoxicillin (AMX) as an empiric third-line rescue therapy. In patients with failure of first-line treatment with a proton pump inhibitor (PPI)-AMX-clarithromycin regimen and second-line treatment with the PPI-AMX-metronidazole regimen, a third-line eradication regimen with rabeprazole (10 mg q.i.d.) and AMX (500 mg q.i.d.) was prescribed for 2 wk. Eradication was confirmed by the results of the ¹³C-urea breath test (UBT) at 12 wk after the therapy. A total of 46 patients were included; however, two were lost to follow-up. The eradication rates as determined by per-protocol and intention-to-treat analyses were 65.9% and 63.0%, respectively. The pretreatment UBT results in the subjects showing eradication failure; those patients showing successful eradication comprised 32.9 ± 28.8 permil and 14.8 ± 12.8 permil, respectively. The pretreatment UBT results in the subjects with eradication failure were significantly higher than those in the patients with successful eradication (P = 0.019). A low pretreatment UBT result (≤ 28.5 permil) predicted the success of the eradication therapy with a positive predictive value of 81.3% and a sensitivity of 89.7%. Adverse effects were reported in 18.2% of the patients, mainly diarrhea and stomatitis. Dual therapy with rabeprazole and AMX appears to serve as a potential empirical third-line strategy for patients with low values on pretreatment UBT.
Toshihiro
T
Nishizawa
Hidekazu
H
Suzuki
Takama
T
Maekawa
Naohiko
N
Harada
Tatsuya
T
Toyokawa
Toshio
T
Kuwai
Masanori
M
Ohara
Takahiro
T
Suzuki
Masahiro
M
Kawanishi
Kenji
K
Noguchi
Toshiyuki
T
Yoshio
Shinji
S
Katsushima
Hideo
H
Tsuruta
Eiji
E
Masuda
Munehiro
M
Tanaka
Shunsuke
S
Katayama
Norio
N
Kawamura
Yuko
Y
Nishizawa
Toshifumi
T
Hibi
Masahiko
M
Takahashi
D053799:2-Pyridinylmethylsulfinylbenzimidazoles / Q000008:administration & dosage*; D000328:Adult; D000368:Aged; D000658:Amoxicillin / Q000008:administration & dosage*; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D000897:Anti-Ulcer Agents / Q000008:administration & dosage; D001944:Breath Tests / Q000379:methods*; D004359:Drug Therapy, Combination / Q000379:methods*; D005260:Female; D016481:Helicobacter Infections / Q000175:diagnosis* / Q000188:drug therapy*; D016480:Helicobacter pylori / Q000187:drug effects*; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D064750:Rabeprazole; D012680:Sensitivity and Specificity; D014508:Urea / Q000032:analysis*
D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000900:Anti-Bacterial Agents; D000897:Anti-Ulcer Agents; D064750:Rabeprazole; D000658:Amoxicillin; D014508:Urea