Efficacy of a “Rescue” Ciprofloxacin-Based Regimen for Eradication ofHelicobacter pyloriInfection after Treatment Failures

Abstract

The aim of our study was to evaluate the efficacy and tolerability of a ciprofloxacin-based regimen for H. pylori eradication failures as an alternative to bismuth based quadruple therapy. Methods. Design: prospective single-center study. Patients in whom a first eradication trial with omeprazole/esomeprazole, clarithromycin plus amoxicillin or tinidazole/metronidazole had failed were included. H. pylori status: established by histology, rapide urease test and polymerase chain reaction. Intervention: esomeprazole 20 mg, ciprofloxacin 500 mg, and metronidazole 500 mg, administered together before breakfast and dinner for 10 days. Susceptibility testing was performed by the Epsilometer test. Ciprofloxacin resistance was defined as a MIC of ≥1 μg/mL. Eradication was established by a negative 13C-UBT and 4–6 weeks post-therapy. Efficacy and side effects were determined. Results. 34 patients were enrolled, 32 completed the study. Compliance was excellent (100%). Side effects were mild. Ciprofloxacin-based therapy cured 65% (22/34) of patients by intention to treat and 69% (22/32) per protocol analysis. The prevalence of ciprofloxacin resistance was 8%. Conclusions. The effectiveness of ciprofloxacin-based therapy was greatly reduced despite the high prevalence of ciprofloxacin sensitive H. pylori strains. Bismuth based quadruple therapy still remain the best choice as a “rescue” regimen in our region.

Systematic review: Would susceptibility‐guided treatment achieve acceptable cure rates for second‐line Helicobacter pylori therapy as currently practiced?

“…Studies reporting duplicate data were excluded. After careful evaluation, 36 studies (including 3466 patients) were found to perform antibiotic susceptibility determinations and were included in the systematic review. Of these 36 articles, 24 reported cure rates according to antibiotic resistances/susceptibilities, including 37 arms of treatment.…”

“…Among these patients, 2890 (83.4%) underwent endoscopy. In 16 of 36 articles, 19,23,24,[26][27][28][29]31,[34][35][36]39,[48][49][50] endoscopy was an inclusion criterion and was performed in all patients; therefore, the rate of acceptance of the procedure could not be evaluated. Nine additional articles performed endoscopy in all patients but did not state whether the procedure was an inclusion criteria or whether patients who rejected endoscopy had been excluded.…”

Helicobacter pylori eradication in Western Australia using novel quadruple therapy combinations

“…Interestingly, although the efficacy of CIP had been reported to underperform in acidic conditions and is currently discouraged by the Maastricht consensus report IV, 1 some studies have shown that the efficacy can be improved by having high dosage of PPI. 39,40 On the other hand, RFB combinations with newer alternative quinolones such as norfloxacin, levofloxacin, moxifloxacin and gatifloxacin have been frequently reported with successful rates >90% in recent years. The consistent success of PARC/PBRC therapy shown in this study suggests that it should be continued as the appropriate combination, at least in Australia and other countries with low quinolone resistance.…”

Two-week bismuth-containing quadruple therapy and concomitant therapy are effective first-line treatments for Helicobacter pylori eradication: A prospective open-label randomized trial

“…Our mBCQT regimen featured twice-daily dosing, unlike previous studies. Dore et al[19] reported that daily two- or four-dose second-line regimens afforded similar eradication rates.…”