Two Different 1-Week Quadruple Therapies Given Back-to-Back Consecutive Therapy for Difficult-to-Treat Helicobacter pylori Infection: A Pilot Study

Abstract

INTRODUCTION: We aim to evaluate the efficacy of 2 different 1-week quadruple therapies given back-to-back consecutive therapy in patients with difficult-to-treat Helicobacter pylori infection. METHODS: Patients with proven H. pylori infection were recruited after >3 failed standard quadruple eradication. They received consecutive therapy consisting of esomeprazole 40 mg or rabeprazole 20 mg twice daily, amoxicillin 1,000 mg twice daily, tetracycline 500 mg 4 times daily, and furazolidone 100 mg 3 times daily for the first 7 days, followed by colloidal bismuth pectin 200 mg twice daily in place of furazolidone 100 mg for another 7 days. Eradication rates, treatment-emergent adverse events (TEAEs), and compliance were assessed. RESULTS: Sixty-five patients were enrolled. The mean number of previous eradications was 3.6 (range: 3–7). The intention-to-treat and per-protocol eradication rates were 90.8% (59/65) and 95.1% (58/61). In total, 23.4% (15/64) of patients experienced drug-related TEAEs. No serious adverse events were observed. None of the patients required treatment for TEAEs, and 95.3% (61/64) showed good compliance. Overall, 51 patients (78.5%) were with the available antimicrobial susceptibility testing results. The resistance rates to clarithromycin, metronidazole, levofloxacin, and amoxicillin were 60.8% (31/51), 100% (51/51), 70.6% (36/51), and 2.0% (1/51), respectively. No resistance was detected to either furazolidone or tetracycline. However, in 54.9% of patients (28/51), H. pylori was resistant to 3 antibiotics (metronidazole, levofloxacin, and clarithromycin). DISCUSSION: Consecutive therapy, including amoxicillin, tetracycline, and furazolidone, achieved a good eradication rate (>90%), with desirable compliance and tolerability in difficult-to-treat H. pylori infection.

Efficacy and safety of a 14‐day modified concomitant therapy for refractory Helicobacter pylori infection: a pilot study

“…Patients aged 18-70 years were eligible for recruitment if they had failed to respond to at least three rounds of H. pylori therapy. The presence of H. pylori was confirmed through at least two positive outcomes of 13 C-urea breath test ( 13 C-UBT), 14 C-UBT, histopathology or culture, or rapid urease test. Patients were excluded from this study if (i) treated with PPI or potassium-competitive acid blockers (P-CAB) in the previous 2 weeks, or antibiotics or bismuth in the previous 4 weeks; (ii) known allergy to medication used in the regimen; (iii) acute gastrointestinal hemorrhage, advanced gastric cancer, or history of gastrectomy; (iv) coexisting any clinically significant condition, such as severe cardiovascular, renal, hepatic, or other system disease; (v) currently pregnant or lactating; (vi) severe neurologic or psychiatric disorders; (vii) alcohol or drug addiction; (viii) compliance was less than 90% in prior treatments; and (ix) unable or unwilling to provide informed consent.…”

“…13 Encouragingly, a previous study reported that consecutive therapy containing three types of antibiotics achieved a satisfactory cure rate (>90%). 14 Considering clinical applicability, an effective and safe empirical therapy is urgently needed to simplify the therapeutic process.…”

“…Meanwhile, a randomized controlled trial (RCT) conducted at our center showed that tailored therapy directed by antimicrobial susceptibility testing (AST) is not superior to empirical bismuth quadruple therapy in the salvage treatment for H. pylori infection 13 . Encouragingly, a previous study reported that consecutive therapy containing three types of antibiotics achieved a satisfactory cure rate (>90%) 14 . Considering clinical applicability, an effective and safe empirical therapy is urgently needed to simplify the therapeutic process.…”