Re-treatment after Helicobacter pylon eradication failure

Gisbert, Javier P.; Boixeda, D; Bermejo, Fernando; Rincón, María-Luisa; Higes, María Jesús de; Arpa, Medeni; Arata, I. García; Argila, Carlos Martín de; Plaza, A García

doi:10.1097/00042737-199909000-00018

Cited by 45 publications

(51 citation statements)

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“…Furthermore, the absence of cross-resistance among nitroimidazoles and clarithromycin favors this position. With this therapy, some authors [Gisbert et al 1999a] have achieved H. pylori eradication in 85% of cases, while others have reported success rates of 86% [Reilly et al 1995] or even 100% [Lerang et al 1997]. In favor of this strategy is the study by Magaret et al [2001], who studied a group of 48 patients after failure of previous H. pylori therapy with a metronidazole-containing regimen, and randomized them to either lansoprazole, amoxicillin and clarithromycin twice daily for 14 days (i.e.…”

Section: Introductionmentioning

confidence: 99%

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Review: Second-line rescue therapy of Helicobacter pylori infection

Gisbert

2009

Therap Adv Gastroenterol

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Helicobacter pylori infection is the main known cause of gastritis, gastroduodenal ulcer disease and gastric cancer. After more than 20 years of experience in H. pylori treatment, however, the ideal regimen to treat this infection has still to be found. Nowadays, apart from having to know well first-line eradication regimens, we must also be prepared to face treatment failures. Therefore, in designing a treatment strategy we should not focus on the results of primary therapy alone, but also on the final (overall) eradication rate. The choice of a 'rescue' treatment depends on which treatment is used initially. If a first-line clarithromycin-based regimen was used, a second-line metronidazole-based treatment (quadruple therapy) may be used afterwards, and then a levofloxacin-based combination would be a third-line 'rescue' option. Alternatively, it has recently been suggested that levofloxacin-based 'rescue' therapy constitutes an encouraging second-line strategy, representing an alternative to quadruple therapy in patients with previous PPI-clarithromycin-amoxicillin failure, with the advantage of efficacy, simplicity and safety. In this case, quadruple regimen may be reserved as a third-line 'rescue' option. Finally, rifabutin-based 'rescue' therapy constitutes an encouraging empirical fourth-line strategy after multiple previous eradication failures with key antibiotics such as amoxicillin, clarithromycin, metronidazole, tetracycline, and levofloxacin. Even after two consecutive failures, several studies have demonstrated that H. pylori eradication can finally be achieved in almost all patients if several 'rescue' therapies are consecutively given. Therefore, the attitude in H. pylori eradication therapy failure, even after two or more unsuccessful attempts, should be to fight and not to surrender.

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Section: Introductionmentioning

confidence: 99%

“…Therefore, a further option which has been proposed is to add (e.g. to PPI-amoxicillinclarithromycin) a fourth medication (as bismuth) with bactericidal effect against H. pylori, with which a 70% eradication rate has been achieved [Gisbert et al 1999a]. …”

Section: Introductionmentioning

confidence: 99%

Review: Second-line rescue therapy of Helicobacter pylori infection

Gisbert

2009

Therap Adv Gastroenterol

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“…An adequate strategy for treating this infection should use two therapies which, if used consecutively, come as close to the 100% cure rate as possible [73]. Eradication rates with quadruple therapy (PPI, bismuth, tetracycline, and a nitroimidazole) as rescue therapy for PPIclarithromycin-amoxicillin failure [29,71,[76][77][78][79][80][81][82]. Eradication rates by intention-totreat analysis when available.…”

Section: Which Is the Best Second-line Treatment For Eradication Failmentioning

confidence: 99%

“…Several studies have obtained relatively good results with this quadruple regimen, being summarized in figure 7 [29,71,[76][77][78][79][80][81][82]. In this combination regimen, PPI should be prescribed in the usual dose and twice a day, colloidal bismuth subcitrate 120 mg four times a day, tetracycline 500 mg four times a day, and metronidazole is probably best prescribed at high doses (i.e., 500 mg three times a day).…”

Section: Which Is the Best Second-line Treatment For Eradication Failmentioning

confidence: 99%

<i>Helicobacter pylori</i> Therapy: First-Line Options and Rescue Regimen

Gisbert

Jm²

2001

Dig Dis

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In the present paper, several points regarding Helicobacter pylori treatment are reviewed, with the following conclusions: (1) all different proton pump inhibitors (PPIs) are equivalent when prescribed with antibiotics; (2) ranitidine bismuth citrate is equal to or, in some cases with antibiotic resistance, more effective than PPI; (3) previous treatment with PPI does not seem to affect the rate of eradication obtained with PPI plus two antibiotics; (4) just 1 week of PPI is enough to obtain duodenal ulcer healing, provided that H. pylori eradication is achieved; (5) the eradication rates seem to be higher in peptic ulcer than in nonulcer dyspepsia; (6) in areas where the prevalence of metronidazole resistance is high, triple therapy including a PPI, clarithromycin, and amoxicillin is the best option, and (7) quadruple therapy (PPI, bismuth, tetracycline, and metronidazole) is the recommended second-line therapy after PPI-clarithromycin-amoxicillin failure, although replacing the PPI and the bismuth compound by ranitidine bismuth citrate achieves also good results.

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“…[4][5][6][7] With the increased use of H. pylori eradication treatments, the overall number of cases of failed eradication has increased. It has been reported that ranitidinebismuth-based triple therapies 8,9 and quadruple therapies [PPI + bismuth + metronidazole (MNZ) + tetracycline] [10][11][12] are the most effective second-line therapies in Western countries. In Japan, because bismuth citrate is not available, the only authorized second-line regimen is triple therapy comprising PPI + amoxycillin (AMPC) + clarithromycin (CAM).…”

Section: Introductionmentioning

confidence: 99%