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Helicobacter pylori first‐line treatment and rescue options in patients allergic to penicillin
Author(s) -
GISBERT J. P.,
GISBERT J. L.,
MARCOS S.,
OLIVARES D.,
PAJARES J. M.
Publication year - 2005
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 - 10.1111/j.1365-2036.2005.02687.x
Subject(s) - medicine , clarithromycin , regimen , metronidazole , rifabutin , omeprazole , helicobacter pylori , proton pump inhibitor , gastroenterology , tolerability , pharmacology , adverse effect , antibiotics , microbiology and biotechnology , biology
Summary Background : Helicobacter pylori eradication is a challenge in patients allergic to penicillin, especially those who have failed a first‐eradication trial. Aim : To assess the efficacy and tolerability of H. pylori first‐line treatment and rescue options in patients allergic to penicillin. Methods : Prospective single centre study including 40 consecutive treatments administered to patients allergic to penicillin. Therapy regimens: First‐line (12 patients) omeprazole, clarithromycin and metronidazole for 7 days; second‐line (17 patients) ranitidine bismuth citrate, tetracycline and metronidazole for 7 days; third‐line (nine patients) rifabutin, clarithromycin and omeprazole for 10 days; and fourth‐line (two patients) levofloxacin, clarithromycin and omeprazole for 10 days. Outcome variable: a negative 13 C‐urea breath test 8 weeks after completion of treatment. Results : Per‐protocol/intention‐to‐treat eradication rates were: first‐line (64/58%); second‐line (ranitidine bismuth citrate; 53/47%); third‐line (rifabutin; 17/11%) and fourth‐line regimen (levofloxacin; 100/100%). Compliance with treatment was generally good, except with the rifabutin‐based regimen, which presented adverse effects in 89% of the patients, including four cases of myelotoxicity. Conclusions : H. pylori ‐infected patients who are allergic to penicillin may be treated with a first‐line treatment combining a proton‐pump inhibitor, clarithromycin and metronidazole. Rescue options may include a regimen with ranitidine bismuth citrate, tetracycline and metronidazole. A levofloxacin‐based rescue regimen (with proton‐pump inhibitor and clarithromycin) may also represent an alternative, even when two or more consecutive eradication treatments have previously failed. However, rifabutin + clarithromycin + proton‐pump inhibitor regimen is ineffective and poorly tolerated.