title: Ten-day Quadruple therapy comprising proton-pump inhibitor, bismuth, tetracycline, and levofloxacin achieves a high eradication rate for Helicobacter pylori infection after failure of sequential therapy.
abstract: BACKGROUND
  Sequential therapy has been recommended in the Maastricht IV/Florence Consensus Report as the first-line treatment for Helicobacter pylori eradication in regions with high clarithromycin resistance. However, it fails in 5-24% of infected subjects, and the recommended levofloxacin-containing triple rescue therapy only achieves a 77% eradication rate after failure of sequential therapy.
  
  
  OBJECTIVE
  To investigate the efficacy of a novel quadruple therapy comprising proton-pump inhibitor, bismuth, tetracycline, and levofloxacin for rescue treatment of sequential therapy.
  
  
  METHODS
  This was a multicenter study in which H. pylori-infected patients who had failed sequential therapy received a 10-day quadruple therapy (esomeprazole (40 mg b.d), tripotassium dicitrato bismuthate (120 mg q.d.s.), tetracycline (500 mg q.d.s.), and levofloxacin (500 mg o.d.) for 10 days). H. pylori status was examined 6 weeks after the end of treatment.
  
  
  RESULTS
  From July 2007 to June 2012, twenty-four subjects received 10-day quadruple therapy. The eradication rates according to intention-to-treat and per-protocol analyses were both 95.8% (23 of 24; 95% confidence interval, 87.8-103.8%). Adverse events were seen in 25.0% (6 of 24) of the patients. Drug compliance was 100.0% (24/24).
  
  
  CONCLUSIONS
  The 10-day quadruple therapy comprising proton-pump inhibitor, bismuth, tetracycline, and levofloxacin achieves a very high eradication rate for H. pylori infection after failure of sequential therapy. It is well tolerated and has great potential to become a good choice of rescue treatment following non-bismuth-containing quadruple therapy in regions with high clarithromycin resistance.
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Veterans General Hospital and National Yang-Ming University, Kaohsiung, Taiwan.
authors.forename: Ping-I
authors.initials: PI
authors.lastname: Hsu
authors.forename: Wen-Chi
authors.initials: WC
authors.lastname: Chen
authors.forename: Feng-Woei
authors.initials: FW
authors.lastname: Tsay
authors.forename: Chih-An
authors.initials: CA
authors.lastname: Shih
authors.forename: Sung-Shuo
authors.initials: SS
authors.lastname: Kao
authors.forename: Huay-Min
authors.initials: HM
authors.lastname: Wang
authors.forename: Hsien-Chung
authors.initials: HC
authors.lastname: Yu
authors.forename: Kwok-Hung
authors.initials: KH
authors.lastname: Lai
authors.forename: Hui-Hwa
authors.initials: HH
authors.lastname: Tseng
authors.forename: Nan-Jing
authors.initials: NJ
authors.lastname: Peng
authors.forename: Angela
authors.initials: A
authors.lastname: Chen
authors.forename: Chao-Hung
authors.initials: CH
authors.lastname: Kuo
authors.forename: Deng-Chyang
authors.initials: DC
authors.lastname: Wu
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000009:adverse effects; D001729:Bismuth / Q000008:administration & dosage* / Q000009:adverse effects; D004359:Drug Therapy, Combination / Q000009:adverse effects / Q000379:methods; D005260:Female; D016481:Helicobacter Infections / Q000188:drug therapy*; D006801:Humans; D064704:Levofloxacin / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D054328:Proton Pump Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D013752:Tetracycline / Q000008:administration & dosage* / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D054328:Proton Pump Inhibitors; D064704:Levofloxacin; D013752:Tetracycline; D001729:Bismuth
keywords: Helicobacter pylori; antibiotic resistance; rescue therapy; sequential therapy