engleski

Time trends in the choice of H. pylori rescue treatment after one or two failures of standard PPI-clarithromycin/metronidazole containing therapy in Referral Centre for H. pylori in Zagreb, Croatia

INTRODUCTION: Almost 10-30% of our patients failed to eradicate H.pylori infection with one or two, 7-14 days, standard triple-therapy regimes. Standard rescue regimen was quadruple bismuth-containing regimen till year 2010. Last two years we started with testing 10-day PPI-levofloxacin-amoxicillin regimen. AIM: Aim was to evaluate the efficacy of two different rescue therapies: prior quadruple bismuth-containing and today’s 10-day PPI-levofloxacin-amoxicillin regimen. METHODS: In first time period (till year 2010.) 143 consecutive claritromycine resistant patients (nonulcer dyspepsia-NUD-63, or peptic ulcer-PUD-80 patients) were treated with 10-day quadruple bismuth-containing regimen (Group A), and in last two years 57 patients with similar diagnoses (NUD-30, and PUD-27 levofloxacin-susceptible patients) were treated with PPI-levofloxacin-amoxicillin regimen (Group B). All patients underwent endoscopy with histology and culture (dilution agar method) at the beginning and endoscopy or 13C-urea breath test 4-8 weeks after the end of the treatment. RESULTS: All strains were sensitive to amoxicillin and tetracycline and in Group B to levofloxacin. Eradication rate with levofloxacin-containing therapy was higher in both, the intention-to-treat (91, 2% vs. 79, 0% ; 95% CI 1, 01-7, 52) and per protocol (94, 5% vs. 83, 1% ; 95% CI 1, 05-12, 58) analysis. CONCLUSION: Both, quadruple and levofloxacin containing therapy, improves the H. pylori eradication rate after failed multiple standard triple therapies, but the protocol containing levofloxacin was significantly better (ITT p=0, 028, PP p=0, 021). The main problem with both rescue treatment in Croatia is that all three drugs (bismuth, tetracycline, and levofloxacin) today are not available, and patients have to pay therapy for themselves, despite fully health insurance.

rescue treatments; quadruple bismuth-containing regimen; PPI-levofloxacin-amoxicillin regimen

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