Background: Helicobacter pylori eradication therapies do not achieve 100% s
uccess rates. Antibiotic resistant strains are among the major causes of fa
ilure. Current recommendations concerning the management of treatment failu
res are not fully clear.
Aim: To evaluate the efficacy of a multi-step therapeutic strategy in a lar
ge group of infected patients.
Methods: A total of 2606 H. pylori-positive patients were administered tini
dazole, clarithromycin and a proton pump inhibitor for 1 week. Patients wit
h continuing infection were then given a second 1-week course of amoxycilli
n, clarithromycin and ranitidine bismuth citrate. Patients still infected a
fter the second course underwent upper gastrointestinal endoscopy with H. p
ylori culture, and then received a 1-week quadruple proton pump inhibitor-b
ismuth based scheme established on H. pylori antibiotic sensitivity.
Results: After the first step, eradication was achieved in 2063 out of 2413
patients [86% per protocol analysis (PP); 79% intention-to-treat analysis
(ITT)]. First-step failures (350 out of 2413; 14.5% PP) showed second-step
eradication rates of 82% (271 out of 329 patients, PP; 77% ITT). The specif
ic quadruple therapy for second-step failures (58 out of 329, 18% PP) achie
ved 77% (30 out of 39 patients, PP) or 52% (ITT) success. This algorithm le
d to overall eradication rates of 99% (PP) or 91% (ITT).
Conclusions: This multi-step strategy succeeded in a high percentage of H.
pylori infected patients. Given the lack of precise guidelines on treatment
failures, assessing H. pylori sensitivity to antibiotics only after failur
e of the second treatment could be suggested in clinical practice.