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Second‐line treatment for failure to eradicate Helicobacter pylori: a randomized trial comparing four treatment strategies
Author(s) -
Lamouliatte H.,
Mégraud F.,
Delchier J.C.,
Bretagne J.F.,
CourillonMallet A.,
De Korwin J.D.,
Fauchère J.L.,
Labigne A.,
Fléjou J.F.,
Barthelemy P.
Publication year - 2003
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.1365-2036.2003.01759.x
Subject(s) - clarithromycin , metronidazole , medicine , helicobacter pylori , amoxicillin , gastroenterology , omeprazole , antibiotics , randomization , randomized controlled trial , urea breath test , breath test , microbiology and biotechnology , helicobacter pylori infection , biology
Summary Aim : To compare the efficacy of different regimens in patients in whom previous Helicobacter pylori eradication therapy has failed. Methods : In this study named StratHegy patients ( n = 287) were randomized to receive one of three empirical triple therapy regimens or a strategy based on antibiotic susceptibility. The empirical regimens were omeprazole, 20 mg b.d., plus amoxicillin, 1000 mg b.d., and clarithromycin, 500 mg b.d., for 7 days (OAC 7 ), clarithromycin, 500 mg b.d., for 14 days (OAC 14 ) or metronidazole, 500 mg b.d., for 14 days (OAM 14 ). In the susceptibility‐based strategy, patients with clarithromycin‐susceptible strains received OAC 14 , whilst the others received OAM 14 . The 13 C‐urea breath test was performed before randomization and 4–5 weeks after eradication therapy. Results : In the intention‐to‐treat analysis, the eradication rates for empirical therapies were as follows: OAC 7 , 47.4% (27/57); OAC 14 , 34.5% (20/58); OAM 14 , 63.2% (36/57); it was 74.3% (84/113) for the susceptibility‐based treatment ( P < 0.01 when compared with OAC 7 and OAC 14 ). In patients receiving clarithromycin, the eradication rates were 80% for clarithromycin‐susceptible strains and 16% for clarithromycin‐resistant strains; in patients receiving OAM 14 , the eradication rates were 81% for metronidazole‐susceptible strains and 59% for metronidazole‐resistant strains. Conclusions : Eradication rates of approximately 75% can be achieved with second‐line triple therapy based on antibiotic susceptibility testing. If susceptibility testing is not available, OAM 14 is an appropriate alternative.