Third line treatment for Helicobacter pylori: a prospective, culture-guided study in peptic ulcer patients

Background: A third line treatment is needed in roughly 5% of patients infe cted with Helicobacter pylori. Few data have been reported on efficacy of t reatment regimens in these patients. Methods: A prospective trial was designed to study the effectiveness of thi rd line treatment of H. pylori infection in ulcer patients. Two-week quadru ple, culture-guided, combinations were used in 31 consecutive patients. Sus ceptibility to metronidazole and clarithromycin were studied by E-test, and thereafter a predetermined treatment regimen was used. Compliance was eval uated by pill count, and eradication defined by negative urea breath test a t 6 weeks. Results: Two main quadruple regimens were used in 29 patients. In spite of good compliance, the combination of omeprazole, tetracycline, bismuth and c larithromycin (OTBC) showed an eradication rate (per protocol analysis) of 36% (five out of 14; CI: 12.8-64.9), and if amoxycillin was used (OTBA) the rate was 67% (eight out of 12; CI: 34.9-90.1). The difference was not sign ificant. No clinical factor was found to be associated with failure to erad icate. Conclusions: Third line treatment often fails to eradicate H. pylori infect ion. New strategies need to be developed and tested for this common clinica l situation.