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High‐dose proton pump inhibitor and amoxicillin dual therapy with or without bismuth for 14 days as rescue therapies after Helicobacter pylori treatment failure
Author(s) -
Goh KheanLee,
Chang Joven,
Leow Alex H.R.
Publication year - 2020
Publication title -
journal of digestive diseases
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.684
H-Index - 51
eISSN - 1751-2980
pISSN - 1751-2972
DOI - 10.1111/1751-2980.12929
Subject(s) - medicine , helicobacter pylori , amoxicillin , gastroenterology , breath test , proton pump inhibitor , urea breath test , confidence interval , intention to treat analysis , helicobacter pylori infection , adverse effect , antibiotics , microbiology and biotechnology , biology
Objective Helicobacter pylori ( H. pylori ) treatment failures are difficult to treat. In this study we aimed to test the efficacy of two high‐dose dual therapy regimens with or without bismuth for 2 weeks as a rescue therapy for patients with previous H. pylori treatment failure. Methods H. pylori ‐positive patients were randomly assigned to either dexlansoprazole 60 mg twice a day and amoxicillin 1 g 4 times a day without (high‐dose dual therapy [HDDT]) or with colloidal bismuth subcitrate 240 mg twice a day (HDDT‐Bi) for 14 days. Eradication of H. pylori was tested using the 13 C‐urea breath test at least 4 weeks (HDDT) or 8 weeks (HDDT‐Bi) after the completion of therapy. Results H. pylori was eradicated in 84.6% (33/39) of patients (95% confidence interval [CI]: 70.3‐92.8%) in the HDDT group, compared with 80.5% (33/41) (95% CI: 66.0‐89.8%) in the HDDT‐Bi group on an intention‐to‐treat (ITT) analysis, and in 89.2% (33/37) (95% CI: 75.3‐95.7%) in the HDDT group compared with 82.5% (33/40) (95% CI: 68.1‐91.3%) in the HDDT‐Bi group on a per‐protocol (PP) analysis. There was no significant difference in the eradication rates in both groups on ITT and PP analysis. Both treatment regimens were well tolerated. Conclusions Adding bismuth to HDDT did not increase H. pylori eradication rates after treatment failure. HDDT and HDDT‐Bi achieved a satisfactory eradication rate of more than 80% as rescue therapies. Both treatment regimens were well tolerated by patients and compliance with treatment was good.