title: Four-times-daily Dosing of Rabeprazole with Sitafloxacin, High-Dose Amoxicillin, or Both for Metronidazole-Resistant Infection with Helicobacter pylori in Japan.
abstract: BACKGROUND
  The bacterial resistance of Helicobacter pylori to antimicrobial agents such as clarithromycin and metronidazole has been increasing worldwide, leading to the failure of eradication treatment. Here, we present an eradication regimen consisting of four-times-daily dosing (q.i.d.) of rabeprazole with potent acid inhibition.
  
  
  OBJECTIVE
  To investigate the efficacy of eradication therapy with rabeprazole q.i.d. and amoxicillin or sitafloxacin in Japanese infected with a metronidazole-resistant strain.
  
  
  METHODS
  We retrospectively investigated the efficacy of eradication regimens with rabeprazole q.i.d. for 7 days in 111 Japanese pooled patients infected with a metronidazole-resistant strain of H. pylori at Hamamatsu University School of Medicine Hospital or the Shiga University of Medical Science Hospital: 1, with sitafloxacin 100 mg twice daily (b.i.d.) (n = 82); 2, with amoxicillin 500 mg q.i.d. (n = 15); and 3, with amoxicillin q.i.d. and sitafloxacin b.i.d.-combined regimen (n = 14). Eradication status was assessed at 8 weeks via a13C-urea breath test.
  
  
  RESULTS
  Eradication rate on intention-to-treat analysis was 93.7% (95% confidence interval: 87.4-97.4%, 104/111), irrespective of the high prevalence of strains resistant to clarithromycin (81.1%, 90/111) and levofloxacin (42.3%, 47/111). No significant differences in eradication rates were observed among the different treatment regimens (p = .408), eradication history (p = .096) and different CYP2C19 genotypes (p = .789). On multivariate analysis, no significant risk factor for eradication failure by therapy with potent acid inhibition was seen.
  
  
  CONCLUSIONS
  In Japanese patients infected with metronidazole-resistant strains of H. pylori, eradication rates exceeding 90% can be achieved using appropriate dosing of antibiotic agents with strain susceptibility (amoxicillin q.i.d. and/or sitafloxacin b.i.d.) together with acid inhibition for a full 24 h and rabeprazole 10 mg q.i.d. These findings may be further evidence for dual therapy with rabeprazole q.i.d. and an antibiotic agent (amoxicillin q.i.d. or sitafloxacin b.i.d.) in Japanese patients with metronidazole-resistant strains.
authors.affiliation: Division of Digestive Endoscopy, Shiga University of Medical Science Hospital, Otsu, Shiga, Japan.|First Department of Medicine, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan.
authors.forename: Mitsushige
authors.initials: M
authors.lastname: Sugimoto
authors.affiliation: First Department of Medicine, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan.
authors.forename: Shu
authors.initials: S
authors.lastname: Sahara
authors.affiliation: First Department of Medicine, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan.
authors.forename: Hitomi
authors.initials: H
authors.lastname: Ichikawa
authors.affiliation: First Department of Medicine, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan.
authors.forename: Takuma
authors.initials: T
authors.lastname: Kagami
authors.affiliation: Division of Digestive Endoscopy, Shiga University of Medical Science Hospital, Otsu, Shiga, Japan.
authors.forename: Hiromitsu
authors.initials: H
authors.lastname: Ban
authors.affiliation: Department of Gastroenterology, Shiga University of Medical Science Hospital, Otsu, Shiga, Japan.
authors.forename: Taketo
authors.initials: T
authors.lastname: Otsuka
authors.affiliation: Department of Gastroenterology, Shiga University of Medical Science Hospital, Otsu, Shiga, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Andoh
authors.affiliation: Center for Clinical Research, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan.
authors.forename: Takahisa
authors.initials: T
authors.lastname: Furuta
mesh_terms: D000328:Adult; D000368:Aged; D000658:Amoxicillin / Q000008:administration & dosage*; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000494:pharmacology; D024881:Drug Resistance, Bacterial; D005260:Female; D024841:Fluoroquinolones / Q000008:administration & dosage*; D016481:Helicobacter Infections / Q000188:drug therapy* / Q000382:microbiology; D016480:Helicobacter pylori / Q000187:drug effects; D006785:Hospitals, University; D006801:Humans; D007564:Japan; D008297:Male; D008795:Metronidazole / Q000494:pharmacology; D008875:Middle Aged; D054328:Proton Pump Inhibitors / Q000008:administration & dosage*; D064750:Rabeprazole / Q000008:administration & dosage*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D024841:Fluoroquinolones; D054328:Proton Pump Inhibitors; D008795:Metronidazole; D064750:Rabeprazole; D000658:Amoxicillin; C076246:sitafloxacin
keywords: 
  Helicobacter pylori
  ; Metronidazole; rabeprazole; resistance to antimicrobial agents