title: Efficacy of a therapeutic strategy for eradication of Helicobacter pylori infection.
abstract: OBJECTIVE
  To determine the efficacy of our therapeutic strategy for Helicobacter pylori (H. pylori) eradication and to identify predictive factors for successful eradication.
  
  
  METHODS
  From April 2006 to June 2010, we retrospectively assessed 2428 consecutive patients (1025 men, 1403 women; mean age 55 years, age range 18-92 years) with gastric histology positive for H. pylori infection referred to our unit for 13-C urea breath test (UBT), after first-line therapy with proton pump inhibitor (PPI) b.i.d. + amoxicillin 1 g b.i.d. + clarithromycin 500 mg b.i.d. for 7 d. Patients who were still positive to UBT were recommended a second-line therapy (PPI b.i.d. + amoxicillin 1 g b.i.d. + tinidazole 500 mg b.i.d. for 14 d). Third choice treatment was empirical with PPI b.i.d. + amoxicillin 1 g b.i.d. + levofloxacin 250 mg b.i.d. for 14 d.
  
  
  RESULTS
  Out of 614 patients, still H. pylori-positive after first-line therapy, only 326 and 19 patients respectively rechecked their H. pylori status by UBT after the suggested second and third-line regimens. "Per protocol" eradication rates for first, second and third-line therapy were 74.7% (95% CI: 72.7%-76.4%), 85.3% (95% CI: 81.1%-89.1%) and 89.5% (95% CI: 74.9%-103%) respectively. The overall percentage of patients with H. pylori eradicated after two treatments was 97.8% (95% CI: 97.1%-98.4%), vs 99.9% (95% CI: 99.8%-100%) after three treatments. The study found that eradication therapy was most effective in patients with ulcer disease (P < 0.05, P = 0.028), especially in those with duodenal ulcer. Smoking habits did not significantly affect the eradication rate.
  
  
  CONCLUSIONS
  First-line therapy with amoxicillin and clarithromycin produces an H. pylori eradication rate comparable or superior to other studies and second-line treatment can still be triple therapy with amoxicillin and tinidazole.
authors.affiliation: Unit of Gastroenterology and Digestive Endoscopy, Arcispedale Santa Maria Nuova, Istituto di Ricovero e Cura a Carattere Scientifico, 42123 Reggio Emilia, Italy. giuliana.sereni@asmn.re.it
authors.forename: Giuliana
authors.initials: G
authors.lastname: Sereni
authors.forename: Francesco
authors.initials: F
authors.lastname: Azzolini
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Camellini
authors.forename: Debora
authors.initials: D
authors.lastname: Formisano
authors.forename: Francesco
authors.initials: F
authors.lastname: Decembrino
authors.forename: Veronica
authors.initials: V
authors.lastname: Iori
authors.forename: Cristiana
authors.initials: C
authors.lastname: Tioli
authors.forename: Maurizio
authors.initials: M
authors.lastname: Cavina
authors.forename: Francesco
authors.initials: F
authors.lastname: Di Mario
authors.forename: Giuliano
authors.initials: G
authors.lastname: Bedogni
authors.forename: Romano
authors.initials: R
authors.lastname: Sassatelli
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000658:Amoxicillin / Q000627:therapeutic use*; D001944:Breath Tests; D017291:Clarithromycin / Q000627:therapeutic use*; D015897:Comorbidity; D060740:Disease Eradication / Q000379:methods*; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D005260:Female; D016481:Helicobacter Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000517:prevention & control*; D016480:Helicobacter pylori; D006801:Humans; D064704:Levofloxacin; D008297:Male; D008875:Middle Aged; D015242:Ofloxacin / Q000627:therapeutic use; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*; D012189:Retrospective Studies; D014011:Tinidazole / Q000627:therapeutic use; D016896:Treatment Outcome; D014456:Ulcer / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D055815:Young Adult
chemical_list: D054328:Proton Pump Inhibitors; D014011:Tinidazole; D064704:Levofloxacin; D000658:Amoxicillin; D015242:Ofloxacin; D017291:Clarithromycin