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Sequential therapy using high‐dose esomeprazole‐amoxicillin followed by gatifloxacin for Helicobacter pylori infection
Author(s) -
GRAHAM D. Y.,
ABUDAYYEH S.,
ELZIMAITY H. M. T.,
HOFFMAN J.,
REDDY R.,
OPEKUN A. R.
Publication year - 2006
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.1365-2036.2006.03072.x
Subject(s) - esomeprazole , gatifloxacin , medicine , amoxicillin , helicobacter pylori , gastroenterology , proton pump inhibitor , side effect (computer science) , antibiotics , levofloxacin , computer science , programming language , microbiology and biotechnology , biology
Summary Background The success rate of current anti‐ Helicobacter pylori triple therapies in now generally 80% or less. Sequential therapy has proved superior. Aim To test a new sequential therapy for H. pylori eradication. Methods This was a pilot study of a sequential therapy consisting of 40 mg of esomeprazole and 1 g amoxicillin t.d.s., for 12 days. On days 6 through 12 gatifloxacin (400 mg in the morning) was added. Outcome was accessed 4 or more weeks after ending antibiotic therapy. Both naive and treatment failures were eligible. Results Thirty patients were entered in the study. One was lost to follow‐up and one stopped early because of side effects. The success rate intention‐to‐treat was 80% (95% CI: 61–92%). The per‐protocol eradication rate was 85.7% (95% CI: 67–95%); two of the four failures had pre‐treatment gatifloxacin‐resistant H. pylori . Side effects were reported by 13 patients (46%) and were generally mild with diarrhoea being most common ( n = 6). Only one patient stopped medicine because of side effects of dizziness (severe) and diarrhoea (mild). Conclusions Sequential therapy using the combination of a high dose of proton‐pump inhibitor and amoxicillin followed gatifloxacin was effective, but pre‐treatment susceptibility testing may become necessary as fluoroquinolone resistance increases.