A triple therapy regimen after failed Helicobacter pylori treatments

Background: Following standard triple therapy, up to 20% of patients requir e further Helicobacter pylori eradication treatment. Data regarding the eff icacy of re-treatment in these patients are scarce. Aim: To evaluate the efficacy of a triple therapy after one or more consecu tive treatment failures. Methods: A total of 51 patients with persistent H. pylori infection after a t least one unsuccessful standard 1-week regimen were enrolled in the study . H. pylori infection at entry was assessed by rapid urease test and histol ogy on biopsies from the antrum and the corpus. Patients were given a 2-wee k triple therapy, comprising ranitidine bismuth citrate 400 mg b.d., tetrac ycline 500 mg t.d.s., and tinidazole 500 mg b.d. Ranitidine bismuth citrate was given during meals, whilst tetracycline and tinidazole was given after meals. Bacterial eradication was assessed by endoscopy (36 patients) or C- 13-urea breath test (15 patients) 4-6 weeks after therapy had ended. Results : All 51 patients completed the study and H. pylori eradication was achieved in 46, with an eradication rate of 90% (95% CI: 82-98). In detail , bacterial eradication was obtained in 96% of patients who had previously failed one course of clarithromycin-amoxicillin based triple therapy, in 88 % patients who had failed a clarithromycin-tinidazole based triple therapy, in 83% patients who had failed both treatment schedules, and in the only p atient who had failed three consecutive therapeutic attempts. Two patients took the therapy for 9 and 10 days instead of the full 14 day-course. No ma jor side-effects were reported, whilst six (12%) patients complained of mil d side-effects. Conclusion: This study demonstrates that this triple therapy regimen is eff ective for re-treatment of H. pylori infection.