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Rescue therapy with bismuth quadruple regimen in patients with Helicobacter pylori ‐resistant strains
Author(s) -
Fiorini Giulia,
Saracino Ilaria Maria,
Zullo Angelo,
Gatta Luigi,
Pavoni Matteo,
Vaira Dino
Publication year - 2017
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.12448
Subject(s) - regimen , medicine , helicobacter pylori , clarithromycin , levofloxacin , metronidazole , esomeprazole , gastroenterology , adverse effect , surgery , antibiotics , microbiology and biotechnology , biology
Background Bismuth quadruple therapy ( BQT ) is the recommended rescue therapy for Helicobacter pylori ( H. pylori ) infection. This study aimed to assess the efficacy and safety of a 10‐day BQT regimen in patients who failed previous therapies and were infected with multiresistant H. pylori strains Materials and methods Helicobacter pylori ‐infected patients underwent endoscopy, culture, and susceptibility test for clarithromycin, metronidazole, and levofloxacin. Treatment with three‐in‐one capsule (Pylera®) four times daily and esomeprazole 20 mg twice daily for 10 days was administered. Treatment‐emergent adverse events ( TEAE s) were registered. Results A total of 116 patients with persistent H. pylori infection following at least one eradication therapy attempt were treated. Overall, resistance toward clarithromycin was detected in 80% of strains, toward metronidazole in 70%, and levofloxacin in 47.5%, with dual or triple resistance in 72.5% of cases. An eradication rate of 81.0% (95% CI : 73.0‐87.1) and 87.0% (95% CI : 79.4‐92.1) at ITT and PP analyses, respectively, was achieved. The cure rate remained high until it was used as fourth‐line regimen, while it dropped to low values (<67%) in those patients with more than 4 therapy failures. A total of 65.7% (95% CI : 56.4‐74.0) patients complained of TEAE s. Conclusions Our data found that bismuth‐based quadruple regimen is effective as rescue therapy for curing patients infected with multiresistant H. pylori strains.