title: Quadruple rescue therapy after first and second line failure for Helicobacter pylori treatment: comparison between two tetracycline-based regimens.
abstract: OBJECTIVE
  Antibiotic resistance is the main reason for failure of Helicobacter pylori (H. pylori) treatment. Currently, guidelines recommend a treatment guided by antimicrobial susceptibility testing after two failures. However, microbial culture is not feasible everywhere, and the limited number of effective antibiotics against the bacterium narrows the options; thus a rescue therapy combining antibiotics with a low resistance may be fitting.
  
  
  METHODS
  Patients who have failed a first-line treatment (either prolonged triple or sequential regimens) and, successively, a levofloxacin-based triple therapy were considered for the study. Subjects underwent urea breath test (UBT), stool antigen test (ST) and endoscopy/histology to confirm the diagnosis. Cytopenia and impaired liver and kidney function were exclusion criteria. Fifty-four subjects were randomized 1:1 to two regimens: RMB Rabeprazole/Rifabutin/Minocycline/Bismuth sub-citrate or MTB Rabeprazole/Tinidazole/Minocycline/Bismuth sub-citrate both for 10 days. The results were checked 6 weeks after the end of therapy with ST/UBT plus endoscopy when indicated.
  
  
  RESULTS
  RMB eradicated the bacterium in 21 patients. Two subjects dropped out. The eradication rate was 77.7% (CI 62.0-93.4%) at intention-to-treat and 84.0% (CI 69.6-98.4%) at per-protocol analysis. MTB was successful in 14 patients (51.9%, CI 33.1-70.7%). No patient withdrew from the treatment for adverse events. Drug-related side effects were reported only in 3 subjects, but in all cases the treatment was carried on.
  
  
  CONCLUSIONS
  The association minocycline/rifabutin seems to have a synergic effect and a good therapeutic outcome in patients who have failed at least two previous regimens, although a trial on a large population is needed.
authors.affiliation: Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy. ierardi. enzo@gmail.com.
authors.forename: Enzo
authors.initials: E
authors.lastname: Ierardi
authors.affiliation: Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Giangaspero
authors.affiliation: Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Losurdo
authors.affiliation: Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy.
authors.forename: Floriana
authors.initials: F
authors.lastname: Giorgio
authors.affiliation: Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy.
authors.forename: Annacinzia
authors.initials: A
authors.lastname: Amoruso
authors.affiliation: Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari; Ospedali Riuniti, Gastroenterology Unit, Foggia, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: De Francesco
authors.affiliation: Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Di Leo
authors.affiliation: Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy.
authors.forename: Mariabeatrice
authors.initials: M
authors.lastname: Principi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000009:adverse effects; D001944:Breath Tests; D024881:Drug Resistance, Bacterial; D004359:Drug Therapy, Combination; D016099:Endoscopy, Gastrointestinal; D005243:Feces / Q000382:microbiology; D005260:Female; D016481:Helicobacter Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology; D016480:Helicobacter pylori / Q000187:drug effects* / Q000472:pathogenicity; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D008911:Minocycline / Q000008:administration & dosage* / Q000009:adverse effects; D009942:Organometallic Compounds / Q000008:administration & dosage; D054328:Proton Pump Inhibitors / Q000008:administration & dosage; D064750:Rabeprazole / Q000008:administration & dosage; D017828:Rifabutin / Q000008:administration & dosage; D013997:Time Factors; D014011:Tinidazole / Q000008:administration & dosage; D017211:Treatment Failure; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D009942:Organometallic Compounds; D054328:Proton Pump Inhibitors; D014011:Tinidazole; D017828:Rifabutin; D064750:Rabeprazole; D008911:Minocycline; C002791:bismuth tripotassium dicitrate