Long-term follow up Helicobacter Pylori reinfection rate after second-line treatment: bismuth-containing quadruple therapy versus moxifloxacin-based triple therapy.
BACKGROUND
The increasing trend of antibiotic resistance requires effective second-line Helicobacter pylori (H. pylori) treatment in high prevalence area of H. pylori. The aim of our study was to evaluate the reinfection rate of H. pylori after second-line treatment that would determine the long-term follow up effect of the rescue therapy.


METHODS
A total of 648 patients who had failed previous H. pylori eradication on standard triple therapy were randomized into two regimens: 1, esomeprazole (20 mg b.i.d), tripotassium dicitrate bismuthate (300 mg q.i.d), metronidazole (500 mg t.i.d), and tetracycline (500 mg q.i.d) (EBMT) or 2, moxifloxacin (400 mg q.d.), esomeprazole (20 mg b.i.d), and amoxicillin (1000 mg b.i.d.) (MEA). At four weeks after completion of eradication therapy, H. pylori tests were performed with 13C urea breath test or invasive tests. In patients who maintained continuous H. pylori negativity for the first year after eradication therapy, H. pylori status was assessed every year. For the evaluation of risk factors of reinfection, gender, age, clinical diagnosis, histological atrophic gastritis or intestinal metaplasia were analyzed.


RESULTS
The recrudescence rate of the EBMT was 1.7% and of the MEA group 3.3% (p = 0.67). The annual reinfection rate of H. pylori of EBMT was found to be 4.45% and the MEA group 6.46%. Univariate analysis (Log-rank test) showed no association with any clinical risk factor for reinfection.


CONCLUSIONS
The long-term reinfection rate of H. pylori stayed low in both of bismuth-containing quadruple therapy and moxifloxacin-based triple therapy; thus reinfection cannot affect the choice of second-line treatment.


BACKGROUND
Clinical Trial Registration Number NCT01792700.
Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, South Korea. nayoungkim49@empas.com.
Min Soo
MS
Kim
Nayoung
N
Kim
Sung Eun
SE
Kim
Hyun Jin
HJ
Jo
Cheol Min
CM
Shin
Young Soo
YS
Park
Dong Ho
DH
Lee
D000368:Aged; D000658:Amoxicillin / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000897:Anti-Ulcer Agents / Q000627:therapeutic use*; D001372:Aza Compounds / Q000627:therapeutic use; D001944:Breath Tests; D018572:Disease-Free Survival; D004359:Drug Therapy, Combination / Q000379:methods; D064098:Esomeprazole / Q000627:therapeutic use*; D005260:Female; D024841:Fluoroquinolones; D005756:Gastritis / Q000150:complications; D016481:Helicobacter Infections / Q000150:complications / Q000188:drug therapy*; D016480:Helicobacter pylori; D006801:Humans; D053208:Kaplan-Meier Estimate; D008137:Longitudinal Studies; D008297:Male; D008795:Metronidazole / Q000627:therapeutic use; D008875:Middle Aged; D000077266:Moxifloxacin; D009942:Organometallic Compounds / Q000627:therapeutic use*; D010437:Peptic Ulcer / Q000150:complications; D011804:Quinolines / Q000627:therapeutic use; D012008:Recurrence; D013274:Stomach Neoplasms / Q000150:complications; D013752:Tetracycline / Q000627:therapeutic use; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D000897:Anti-Ulcer Agents; D001372:Aza Compounds; D024841:Fluoroquinolones; D009942:Organometallic Compounds; D011804:Quinolines; D008795:Metronidazole; D000658:Amoxicillin; D013752:Tetracycline; C002791:bismuth tripotassium dicitrate; D064098:Esomeprazole; D000077266:Moxifloxacin