G. Battaglia et al., STRATEGY FOR THE RETREATMENT OF FAILED HELICOBACTER-PYLORI ERADICATION THERAPY - A CASE SERIES, Italian Journal of Gastroenterology and Hepatology, 30(4), 1998, pp. 370-374
Background. Helicobacter pylori eradication therapy can be unsuccessfu
l in 5 to 20% of patients. Aim. To investigate the validity of a strat
egy using triple therapies for the retreatment of patients with eradic
ation failure, avoiding retreatment with antibiotics prone to induce r
esistance after use in the first treatment. Patients and Methods. From
a consecutive sampling of 108 patients still Helicobacter pylori-posi
tive after a first course of antibiotic-based treatment 74 (68.5%) agr
eed to a second course of triple therapy. Group I (N = 17): treatment
failures on an imidazole (I)-based therapy were retreated with clarith
romycin (C)-based regimen; Group 2 (N = 28): failures on a C-based the
rapy with an I-based regimen; Group 3 (N = 7): failures on an IC-based
therapy using an I-based regimen and Group 4 (N = 22): failures on a
non-I/non-C based therapy with either an I-based, C-based or IC-based
regimen. The presence of Helicobacter pylori was assessed by histology
and the CLO-test at study entry and two months after stopping therapy
Results. Nine patients were withdrawn from the study (12.2%) due to a
lack of end point endoscopy. Helicobacter pylori tvas cured after the
second course of therapy in all but seven patients [10.7% failure by
Per Protocol analysis, 21.6% by Intention-To-Treat analysis]. No stati
stically significant differences were found between the four groups (G
roup 1: 92.9% PP, 76.5% ITT; Group 2: 90.9% PT: 71.4% ITT; Group 3: PP
and ITT 85.7%; Group 4: PP and ITT 86.4%). Minor adverse events were
experienced in nine, none of whom required withdrawal from the drug th
erapy Conclusions. A second course of triple therapy with alternate an
tibiotics effectively eradicated Helicobacter pylori, with only very f
ew treatment failures. This suggests that the therapeutic strategy emp
loyed may be recommended.