Open AccessEmpirical Helicobacter pylori rescue therapy: an 18‐year single‐centre study of 1200 patients
Author(s) -
BurgosSantamaría Diego,
McNicholl Adrian G.,
Gisbert Javier P.
Publication year - 2019
Publication title -
gastrohep
Language(s) - English
Resource type - Journals
ISSN - 1478-1239
DOI - 10.1002/ygh2.372
Subject(s) - medicine , helicobacter pylori , proton pump inhibitor , rifabutin , levofloxacin , regimen , amoxicillin , breath test , metronidazole , gastroenterology , lansoprazole , antibiotics , clarithromycin , microbiology and biotechnology , biology
Summary Background Many changes have been made to the guidelines on rescue treatments for Helicobacter pylori infection due to their poor effectiveness in clinical practice. Objective To evaluate the use and effectiveness of different empirical rescue therapies for H. pylori infection in a specialised consultation unit over 18 years. Methods Design : analysis of a systematic, prospective, single‐centre data record. Patients : consecutive patients in whom at least one H. pylori eradication regimen had failed. Intervention : consecutive rescue therapies were prescribed empirically according to the best scientific evidence. Helicobacter pylori eradication was defined by a negative 13 C‐urea breath test. Results A total of 1200 subjects were included. Eleven different therapies were used during the study period, being the seven most common: proton pump inhibitor (PPI)‐levofloxacin (LEV)‐amoxicillin (AMO); PPI‐bismuth(BIS)‐LEV‐AMO; PPI‐moxifloxacin‐AMO; ranitidine bismuth citrate‐tetracycline‐metronidazole; classical BIS (BIS)‐containing quadruple therapy; PPI‐Pylera ® and PPI‐rifabutin (RIF)‐AMO. The effectiveness of the second‐, third‐, fourth‐ and fifth‐line rescue therapies was 77%, 71%, 60% and 58%, respectively. The cumulative effectiveness after five consecutive therapies was 99.8%. The three most effective second‐ and third‐line therapies were: PPI‐Pylera ® (96% and 82%, respectively), classical BIS‐containing quadruple therapy (92% and 89%) and PPI‐BIS‐LEV‐AMO (88% and 84%). Conclusions Helicobacter pylori eradication can be achieved virtually in all cases by the administration of several consecutive empirical therapies. The most effective second‐line strategy is the administration of a BIS‐containing quadruple therapy (either classical, Pylera ® or with LEV‐AMO). The most effective third‐line strategy is the administration of a not previously used BIS‐containing quadruple therapy. A good alternative as a fourth‐line therapy is the administration of PPI‐RIF‐AMO‐BIS.