title: Efficacy of Clarithromycin Containing Bismuth-Based Regimen as a Second-Line Therapy in Helicobacter Pylori Eradication.
abstract: BACKGROUND The eradication of Helicobacter pylori infection, commonly prevailing in the stomach, has been important since its introduction. Adequate preparations should be made in finding alternatives when faced with first-line treatment failures. Currently, ideal second-line treatments are indistinct and varied among countries as result of different antibiotic resistance patterns. We aimed to evaluate the safety and efficacy of a clarithromycin-containing bismuth-based quadruple regimen as a second-line treatment. METHODS Forty-eight H.pylori-positive patients with proven gastric or duodenal ulcers and/or erosions who had previously failed to respond to furazolidone-containing regimens were enrolled. They received pantoprazole (40 mg-bid), amoxicillin (1gr-bid), bismuth subcitrate (240 mg-bid), and clarithromycin (500mg-bid) for 10 days. Eight weeks after treatment, a (14)C-urea breath test was performed for the re-evaluation of H. pylori eradication. RESULTS Forty-three patients completed the study. H.pylori eradication rates were 79.2% (95% CI=65.00-89.53) and 88.4% (95% CI=74.91-96.11) according to intention-to-treat and per-protocol analyses, respectively. All patients had excellent compliance to treatment and one did not continue therapy because of adverse effects. CONCLUSION In developing countries such as Iran, a ten-day clarithromycin-containing bismuth-based quadruple regimen is encouraged as a second-line treatment because of the acceptable rate of eradication and low adverse effects.
authors.affiliation: Colorectal Research Center (CRRC), Rasoul Akram Hospital, Iran University of Medical Sciences (IUMS), Tehran, Iran.
authors.forename: Marjan
authors.initials: M
authors.lastname: Mokhtare
authors.affiliation: Colorectal Research Center (CRRC), Rasoul Akram Hospital, Iran University of Medical Sciences (IUMS), Tehran, Iran.
authors.forename: Shahram
authors.initials: S
authors.lastname: Agah
authors.affiliation: Inflammatory Diseases of the Upper Gastrointestinal Tract Research Center, Mazandaran University of Medical Sciences, Sari, Iran.
authors.forename: Hafez
authors.initials: H
authors.lastname: Fakheri
authors.affiliation: Inflammatory Diseases of the Upper Gastrointestinal Tract Research Center, Mazandaran University of Medical Sciences, Sari, Iran.
authors.forename: Vahid
authors.initials: V
authors.lastname: Hosseini
authors.affiliation: Colorectal Research Center (CRRC), Rasoul Akram Hospital, Iran University of Medical Sciences (IUMS), Tehran, Iran.
authors.forename: Mohsen
authors.initials: M
authors.lastname: Rezaei Hemami
authors.affiliation: Colorectal Research Center (CRRC), Rasoul Akram Hospital, Iran University of Medical Sciences (IUMS), Tehran, Iran ; Medical Student Research Committee (MSRC),Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran.
authors.forename: Seyed Mohammad Sadegh
authors.initials: SM
authors.lastname: Ghafoori
keywords: Clarithromycin; Furazolidone; Helicobacter pylori; Second-line therapy