Cure of Helicobacter pylori infection after failed primary treatment: One-center results from 120 patients

Background: Treatment with a proton pump inhibitor (PPI) and antimicrobials cures Helicobacter pylori infection in about 90% of patients. This is a re trospective overview of our studies aiming to cure the infection in all com pliant patients with failed initial therapy. Methods: We retreated 120 (19% of 644) H. pylori-infected patients whose initial therapy had failed. The retreatments included (i) triple therapy (TT): colloidal bismuth subcitrate , metronidazole, amoxicillin (or tetracycline); (ii) quadruple therapy (QT) : TT and a PPI; or (iii) high doses of both a PPI and clarithromycin combin ed with a further 1-3 individually selected antimicrobials. The eradication results were determined after 6-12 months. Results: The Ist retreatment wa s successful in 70 of 120 patients. The 2nd retreatment cured 25 of the rem aining 42 patients, the 3rd 13 of 17, and the 4th the last 4 patients. The cumulative eradication rate (ITT) was 93% (95% CI: 88.9%-97.9%; 8 patients withdrew after a failed Ist retreatment) and the rate was 100% in the remai ning 112 patients who accepted several retreatments. The Ist retreatment wi th TT cured 23% (95% CI: 12%-34%) of 57 patients and QT 85% (95% CI: 74%-96 %) of 41 patients who had initially undergone a failed metronidazole-based treatment. All retreatments were well tolerated. Conclusions: In this study , high doses of a PPI and clarithromycin combined with 1-3 antimicrobials a ccording to susceptibility data proved to be the best drug combination in t he cure of H, pylori infection after failed primary treatment. Giving imida zole- and bismuth-based QT (without clarithromycin) as the first-line treat ment of H. pylori infection ensures that the number of failures remains low .