Twelve-day quintuple regime containing four antibiotics as a rescue therapy for Helicobacter pylori eradication in the central region of Portugal
2017
Background: Helicobacter pylori eradication rates with
standard triple therapy in many countries are clinically unacceptable.
Fluoroquinolone resistance is increasing and jeopardizing secondline
regimens. There is a growing need for an effective strategy in
patients who failed previous therapies.
Methods: This is a single-center, non-randomized clinical study
conducted in the central region of Portugal. Sixty-four patients were
included with a positive 13C-urea breath test (UBT) or histology for
H. pylori, and at least one failed eradication attempt. The patient
cohort included 71.7% of females with a median of age of 52 (range
23-87). They were treated with a twelve-day regimen consisting of
a proton-pump inhibitor (PPI) bid, amoxicillin at 1,000 mg 12/12h
and levofloxacin at 500 mg bid during the first seven days, followed
by PPI bid, clarithromycin at 500 mg 12/12 h and either tinidazole
or metronidazole at 500 mg bid/tid for five days. Eradication was
assessed by UBT. The local Ethics Committee approved this study.
Results: Eradication therapy was prescribed due to dyspepsia
(66.7%), peptic ulcer (10%) and thrombocytopenia (8.3%). The
median number of failed therapies was one (range 1-4). The
eradication rate was 64.6% according to an intention-to-treat
analysis (95% CI: 53-77%), and 70% by the per-protocol analysis
(95% CI: 58-82%). Age, smoking, indication for eradication,
previous therapies and the use of a second-generation or full-dose
PPI did not affect success rates.
Conclusions: Even though treatment with four antibiotics
was used, this “reinforced” therapy achieved suboptimal results.
This fact highlights the lack of effective H. pylori antimicrobials
and suggests that second-line treatment in our region should be
prescribed according to susceptibility testing.
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