THE MANAGEMENT OF FAILED DUAL OR TRIPLE THERAPY FOR HELICOBACTER-PYLORI ERADICATION

Background: After each treatment for Helicobacter pylori infection the re is an eradication failure rate ranging from 5 to 50%, Thus, the bes t therapy schedule and treatment regimen sequence have still to be ide ntified. Methods: Patients with H. pylori infection were randomized to receive either a 1-week triple therapy of omeprazole 20 mg b.d., clar ithromycin 250 mg b.d. and tetracycline 500 mg b.d. (OCT; 78 patients) or a 2-week dual therapy of omeprazole 20 mg b.d. and amoxycillin 1 g b.d. (OA; 75 patients), H. pylori infection at entry and eradication 4-6 weeks after therapy had ended were assessed by rapid urease test a nd histology on biopsies from the antrum and the corpus, When eradicat ion did not occur with either the OCT or OA regimens, patients were sw itched over to the OA or OCT therapy, respectively. Eradication in the se patients was assessed 4-6 weeks after conclusion of treatment by a further endoscopy. Results: H. pylori eradication was achieved in 67.9 % (95% CI = 57.6-78.3%) of patients treated with the OCT regimen and i n 75.7% (95% CI = 65.9-85.5%) of patients treated with the OA therapy (chi(2) = 1.11; P = 0.29), Moreover, H. pylori eradication was achieve d in 39.1% (95% CI = 19.2-59.1%) of patients re-treated with the OA re gimen and in 88.9% (95% CI = 74.4-100%) of patients re-treated with th e OCT therapy (chi(2) = 8.52; P = 0.003). Thus, the overall success ra te 'per protocol' analysis in our study was 81.6% (95% CI = 72.9-90.3% ) for the triple and dual therapy sequence and 97.3% (95% CI = 93.6-10 0%) for dual followed by triple therapy (chi(2) = 8.14; P = 0.004). Co nclusions: Our data found that H. pylori eradication with OA therapy a fter OCT therapy failure was poor, while that obtained with OCT after OA therapy was good.