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Triple Therapy with High‐Dose Proton‐Pump Inhibitor, Amoxicillin, and Doxycycline Is Useless for H elicobacter pylori Eradication: A Proof‐of‐Concept Study
Author(s) -
Almeida Nuno,
Romãozinho José M.,
Donato Maria M.,
Luxo Cristina,
Cardoso Olga,
Cipriano Maria A.,
Marinho Carol,
Sofia Carlos
Publication year - 2014
Publication title -
helicobacter
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.206
H-Index - 79
eISSN - 1523-5378
pISSN - 1083-4389
DOI - 10.1111/hel.12106
Subject(s) - amoxicillin , helicobacter pylori , medicine , etest , clarithromycin , urea breath test , gastroenterology , doxycycline , adverse effect , regimen , proton pump inhibitor , antibiotics , metronidazole , microbiology and biotechnology , biology , helicobacter pylori infection
H elicobacter pylori resistance to antibiotics is steadily increasing and multidrug‐resistant strains are common and difficult to eliminate, mainly in countries where bismuth, tetracycline, furazolidone, and rifabutin are unavailable. Aim To evaluate the efficacy and safety of a triple therapy with proton‐pump inhibitor ( PPI ), amoxicillin, and doxycycline in patients with multidrug‐resistant H . pylori . Patients and Methods This prospective study involved 16 patients (13 females; mean age – 50 ± 11.3 years) infected by H . pylori with known resistance to clarithromycin, metronidazole, and levofloxacin, but susceptibility to amoxicillin and tetracycline. All patients were previously submitted to upper endoscopy with gastric biopsies for H . pylori culture and susceptibility testing by Etest. Mutations in 23S r RNA and gyrA genes were determined by real‐time PCR. A 10‐day eradication regimen with PPI (double‐standard dose b.i.d.), amoxicillin (1000 mg b.i.d.), and doxycycline (100 mg b.i.d.) was prescribed after pretreatment with PPI during 3 days. Eradication success was assessed by 13 C‐urea breath test 6–10 weeks after treatment. Compliance and adverse events were determined through phone contact immediately after treatment and specific written questionnaires. Results Only one patient did not complete treatment due to adverse events. Another four patients experienced mild side effects not affecting compliance. The control 13 C‐urea breath test was positive in all patients. Per‐protocol and intention‐to‐treat eradication rates were 0%. Conclusions Although safe, a triple‐therapy protocol with high‐dose PPI , amoxicillin, and doxycycline is useless for multidrug‐resistant H . pylori eradication.