THERAPEUTIC OPTIONS AFTER FAILED HELICOBACTER-PYLORI ERADICATION THERAPY

Objectives: Many of the currently used Helicobacter pylori eradication regimens fail to cure 5-20% of the patients, Those patients will rema in at risk of developing a potentially fatal complication of peptic ul cer disease. Therefore, a new attempt to cure H. pylori infection afte r initial failure of therapy is indicated, We studied the efficacy of three retreatment regimens after initial failure of omeprazole-amoxici llin dual therapy. Methods: Fifty-three patients whose treatment faile d were randomly assigned to receive retreatment with the same regimen of omeprazole 20 mg b.i.d. (group I) or omeprazole 40 mg t.i.d. (group II) plus amoxicillin 750 mg t.i.d. for 14 days. Forty patients in who m the omeprazole-amoxicillin retreatment failed were assigned to recei ve omeprazole 20 mg b.i.d., amoxicillin 750 mg t.i.d., and metronidazo le 500 mg t.i.d. for 14 days (group III) or omeprazole 20 mg b.i.d. pl us clarithromycin 500 mg t.i.d. for 14 days (group IV), H. pylori infe ction was assessed by culture and histology of gastric biopsies before and 4-6 wk after cessation of therapy. Susceptibility of H. pylori to amoxicillin, clarithromycin, and metronidazole was determined by the E test, Results: In groups I (n = 28) and II (n = 25), cure of H. pylo ri infection was achieved in 21% and 28% of patients, respectively (no t significant). In groups III (n = 20) and IV (n = 20), H. pylori infe ction was cured in 75% and 70%, respectively, Conclusions: Retreatment with an identical omeprazole-amoxicillin dual regimen is of limited b enefit, a result that is independent of the omeprazole dose. In contra st, a third H. pylori eradication attempt with omeprazole-clarithromyc in dual therapy or omeprazole-amoxicillin-metronidazole triple therapy provides reasonable cure rates after failure of omeprazole-amoxicilli n dual therapy.