The effect of culture results for Helicobacter pylori on the choice of treatment following failure of initial eradication

Citation
B. Avidan et al., The effect of culture results for Helicobacter pylori on the choice of treatment following failure of initial eradication, ISR MED ASS, 3(3), 2001, pp. 163-165
Citations number
21
Language
INGLESE
art.tipo
Article
Categorie Soggetti
General & Internal Medicine
Journal title
ISRAEL MEDICAL ASSOCIATION JOURNAL
ISSN journal
1565-1088 → ACNP
Volume
3
Issue
3
Year of publication
2001
Pages
163 - 165
Database
ISI
SICI code
1565-1088(200103)3:3<163:TEOCRF>2.0.ZU;2-L
Abstract
Background: Current treatment for the eradication of Helicobacter pylori in patients with peptic disease is based on the combination of antibiotic and anti-acid regimens. Multiple combinations have been investigated, however no consensus has been reached regarding the optimal duration and medication s,; Objectives: To assess the efficacy of two treatment regimens in patients wi th peptic ulcer disease and non-ulcer dyspepsia, and to determine the need for gastric mucosal culture in patients failing previous treatment. Methods: Ninety patients with established peptic ulcer and NUD (with previo usly proven ulcer) were randomly assigned to receive either bismuth-subcitr ate, amoxycillin and metronidazole (BAM) or lansoprazole, clarithromycin an d metronidazole (LCM) for 7 days. Patients with active peptic disease were treated with ranitidine 300 mg/day for an additional month. Results: Eradication failed in 8 of the 42 patients in the BAM group and in 2 of the 43 patients in the LCM group, as determined by the C-13 urea brea th test or rapid urease test (19% vs. 5% respectively, P=0.05). Five of the se 10 patients were randomly assigned to treatment with lansoprazole, amoxy cillin and clarithromycin (LAC) regardless of the culture,obtained, and the other 5 patients were assigned to treatment with lansoprazole and two anti bacterial agents chosen according to a susceptibility test. Eradication of H. pylori was confirmed by the 13C urea breath test. The same protocol (LAC ) was used in all patients in the first group and in four of the five patie nts in the second group. The culture results did not influence the treatmen t protocol employed. Conclusions: Combination therapy based on proton pump inhibitor and two ant ibiotics is superior to bismuth-based therapy for one week. Gastric-mucosal culture testing for sensitivity of H, pylori to antibiotics is probably un necessary before the initiation of therapy for patients with eradication fa ilure.