The efficacy of a 14-day modified quadruple therapy containing amoxicillin, tetracycline and high dose metronidazole and proton-pump inhibitors as an empirical third line helicobacter pylori eradication treatment in Taiwan

Abstract

1 amoxicillin, tetracycline and high dose metronidazole and proton-pump 2 inhibitors as an empirical third line helicobacter pylori eradication 3 treatment in Taiwan 4 Abstract 35The antibiotics resistances to amoxicilln, tetracycline was low in Taiwan even after multiple H. 36pylori treatment failures and high dose metronidazole could overcome antibiotics resistance. 37In real world practice, susceptibility-guided treatments are not widely available. Therefore, 38 we assessed the efficacy of 14-day modified quadruple therapy containing amoxicillin, 39 tetracycline and high dose metronidazole and PPI as an empirical third-line rescue H. pylori 40 treatment. This study was conducted by analyzing 70 consecutive prospectively registered 41 patients who failed two times H. pylori eradication. All of them received endoscopy for H. 42 pylori culture. Seven patients were lost to follow up. They were then treated according to the 43 antibiotic susceptibility testing reports (Cultured group, n=39). Those who failed H. pylori 44 culture were prescribed with a modified 14-day quadruple therapy containing esomeprazole 45 40 mg twice daily, amoxicillin 1 g twice daily, tetracycline 500 mg four times daily and 46 metronidazole 500 mg three times daily (empirical group, n=24). Follow-up urea breath 47 56 Keywords: Third line Helicobacter pylori eradication; empirical quadruple therapy; 57 culture-guided therapy. 58 5 129 Multivariate analysis, culture vs. empirical therapy was the only clinical factor influencing H. 130 pylori eradication (OR: 0.16, 95% CI: 0.04-0.60, p=0.006) (Table 6). 131 132 Discussion 133 According to Maastricht V/Florence Consensus Report (11), after failure of second line 134