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Salvage therapies after failure of Helicobacter pylori eradication with ranitidine bismuth citrate‐based therapies
Author(s) -
Francis K.L. Chan,
Joseph J.Y. Sung,
R. Suen,
Justin C. Y. Wu,
T. K. W. Ling,
S. C. S. Chung
Publication year - 2000
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1046/j.1365-2036.2000.00674.x
Subject(s) - clarithromycin , medicine , omeprazole , helicobacter pylori , metronidazole , gastroenterology , proton pump inhibitor , ranitidine hydrochloride , ranitidine , amoxicillin , urea breath test , pharmacology , surgery , antibiotics , helicobacter pylori infection , microbiology and biotechnology , biology
Background: Salvage therapies after initial Helicobacter pylori eradication failure of ranitidine bismuth citrate (RBC)‐based regimens remain undefined. Aim: To test the efficacy of 1‐week omeprazole, amoxycillin and clarithromycin as a second‐line treatment and 1‐week quadruple therapy after repeated failures of RBC‐ and proton pump inhibitor‐based regimens. Method: Patients were recruited from a recently published prospective randomized study if confirmed to have failed H. pylori eradication with RBC‐based regimens. They were given omeprazole 20 mg, amoxycillin 1 g and clarithromycin 500 mg (OAC) b.d. for 1 week. 13 C‐urea breath test was performed 4 weeks after the conclusion of medication. Those who failed to respond to OAC were given 1‐week quadruple therapy (bismuth subcitrate 120 mg, tetracycline 500 mg and metronidazole 400 mg q.d.s. plus omeprazole 20 mg b.d.). Results: Among 398 patients receiving RBC‐based therapies, 40 (10%) had failed eradication (RAC=7, RC‐2=12, RMC=7, and RMT=14). OAC was prescribed to 31 patients (RAC=4, RC‐2=9, RMC=6, and RMT=12) and 68% had successful eradication. Nine out of 10 patients with failed second treatment received quadruple therapy; successful eradication occurred in 83% (5 out of 6) after repeated failures of clarithromycin‐based regimens. Conclusion: One‐week OAC is not an optimal second‐line therapy when RBC‐clarithromycin combinations fail. Quadruple therapy appears to be effective despite repeated failures of clarithromycin‐based RBC or proton pump inhibitor therapies.