Naslov
Helicobacter pylori therapy after failure of two eradication treatments ; a randomized trial comparing two quadruple treatment strategies

Autori
Katičić, Miroslava ; Tićak, Mirjana ; Naumovski-Mihalić, Slavicsa ; Prskalo, Marija ; Šabaric, Branka ; Škurla, Bruno ; Čolić-Cvrlje, Vesna ; Filipec-Kanižaj, Tajana ; Papa, Branko

Vrsta, podvrsta i kategorija rada
Sažeci sa skupova, sažetak, znanstveni

Izvornik
Gut 2005 ; 54 (Suppl VII), British Medical Journals / Robin C. Watson - London : Delhi : Georg Thieme Verlag, 2005

Skup
The 13th United European Gastroenterology week

Mjesto i datum
Kopenhagen, Danska, 15.10.2005. - 19.10.2005

Vrsta sudjelovanja
Poster

Vrsta recenzije
Međunarodna recenzija

Ključne riječi
Helicobacter pylori; eradication failure; quadruple therapy
(Helicobacter pylori; eradikacijski neuspjeh; četverostruka terapija)

Sažetak
INTRODUCTION: Even with the current most effective treatment regimens, about 10-20% of patients will fail to eradicate Helicobacter pylori infection. The choice of a second-line treatment depends on which treatment was used initially, because retreatment with the same regimen is not recommended. The eradication failures are essentially related to the development of antimicrobial agents resistance, mainly concerning macrolides and nitro-imidazoles. Quadruple therapy with proton pump inhibitor, bismuth, tetracycline and metronidazole has been proposed in Maastricht Consensus Conference as the optimal rescue therapies. AIMS & METHODS: Our aim was to evaluate the efficacy of two different quadruple rescue therapies prescribed to patients in whom two or more 7-days H. pylori standard eradication triple therapy regimens had failed. 143 consecutive patients with nonulcer dyspepsia (63) or prior peptic ulcer disease (80) divided in 2 groups, were enrolled in this study, after the failure of at least two 1-week standard triple therapy regimens and with proven metronidazole and clarithromycin resistance by dilution agar methods. They were randomized to receive 10-days quadruple therapy consisting of pantoprazole (2x40mg), coloidal bismuth (4x120 mg), tetracycline (4x250mg) and: group A (68 patients) amoxicillin (2x1000mg), and group B (75 patients) metronidazole (2x500mg). Endoscopy was performed before treatment, with 4 biopsies (2 from antrum and 2 from corpus) for histology and culture. Eight weeks later, an endoscopy or 13C-urea breath test was used to define the success of H. pylori eradication. RESULTS: All strains were sensitive to amoxicillin and tetracycline. Eradication rates with B therapy were slightly higher in both the intention-to-treat (79% vs. 74% ; 95% CI 0.58-1.04) and per protocol (83% vs. 76% ; 95% CI 0.55-1.20) analysis, but the differences were not statistically significant. There were no significant differences in compliance or adverse events between the therapies. CONCLUSION: Quadruple therapy, including metronidazole or amoxicillin, improves the H. pylori eradication rate after failed multiple standard 1-week triple therapies. Protocol containing metronidazole were slightly better then those containing amoxicillin, even dough all patients had been infected with H. pylori with metronidazole resistance and amoxicillin sensitivity.

Izvorni jezik
Engleski

Znanstvena područja
Kliničke medicinske znanosti

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