Fkl. Chan et al., Salvage therapies after failure of Helicobacter pylori eradication with ranitidine bismuth citrate-based therapies, ALIM PHARM, 14(1), 2000, pp. 91-95
Background: Salvage therapies after initial Helicobacter pylori eradication
failure of ranitidine bismuth citrate (RBC)-based regimens remain undefine
d.
Aim: To test the efficacy of 1-week omeprazole, amoxycillin and clarithromy
cin as a second-line treatment and 1-week quadruple therapy after repeated
failures of RBC- and proton pump inhibitor-based regimens.
Method: Patients were recruited from a recently published prospective rando
mized study if confirmed to have failed H. pylori eradication with RBC-base
d regimens. They were given omeprazole 20 mg, amoxycillin 1 g and clarithro
mycin 500 mg (OAC) b.d. for 1 week. C-13-urea breath test was performed 4 w
eeks after the conclusion of medication. Those who failed to respond to OAC
were given 1-week quadruple therapy (bismuth subcitrate 120 mg, tetracycli
ne 500 mg and metronidazole 400 mg q.d.s. plus omeprazole 20 mg b.d.).
Results: Among 398 patients receiving RBC-based therapies, 40 (10%) had fai
led eradication (RAC=7, RC-2=12, RMC=7, and RMT=14). OAC was prescribed to
31 patients (RAC=4, RC-2=9, RMC=6, and RMT=12) and 68% had successful eradi
cation. Nine out of 10 patients with failed second treatment received quadr
uple therapy; successful eradication occurred in 83% (5 out of 6) after rep
eated failures of clarithromycin-based regimens.
Conclusion: One-week OAC is not an optimal second-line therapy when RBC-cla
rithromycin combinations fail. Quadruple therapy appears to be effective de
spite repeated failures of clarithromycin-based RBC or proton pump inhibito
r therapies.