The effect of culture results for Helicobacter pylori on the choice of treatment following failure of initial eradication

Background: Current treatment for the eradication of Helicobacter pylori in patients with peptic disease is based on the combination of antibiotic and anti-acid regimens. Multiple combinations have been investigated, however no consensus has been reached regarding the optimal duration and medication s,; Objectives: To assess the efficacy of two treatment regimens in patients wi th peptic ulcer disease and non-ulcer dyspepsia, and to determine the need for gastric mucosal culture in patients failing previous treatment. Methods: Ninety patients with established peptic ulcer and NUD (with previo usly proven ulcer) were randomly assigned to receive either bismuth-subcitr ate, amoxycillin and metronidazole (BAM) or lansoprazole, clarithromycin an d metronidazole (LCM) for 7 days. Patients with active peptic disease were treated with ranitidine 300 mg/day for an additional month. Results: Eradication failed in 8 of the 42 patients in the BAM group and in 2 of the 43 patients in the LCM group, as determined by the C-13 urea brea th test or rapid urease test (19% vs. 5% respectively, P=0.05). Five of the se 10 patients were randomly assigned to treatment with lansoprazole, amoxy cillin and clarithromycin (LAC) regardless of the culture,obtained, and the other 5 patients were assigned to treatment with lansoprazole and two anti bacterial agents chosen according to a susceptibility test. Eradication of H. pylori was confirmed by the 13C urea breath test. The same protocol (LAC ) was used in all patients in the first group and in four of the five patie nts in the second group. The culture results did not influence the treatmen t protocol employed. Conclusions: Combination therapy based on proton pump inhibitor and two ant ibiotics is superior to bismuth-based therapy for one week. Gastric-mucosal culture testing for sensitivity of H, pylori to antibiotics is probably un necessary before the initiation of therapy for patients with eradication fa ilure.