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Comparison of Amoxicillin–Metronidazole Plus Famotidine or Lansoprazole for Amoxicillin–Clarithromycin–Proton Pump Inhibitor Treatment Failures for Helicobacter pylori Infection
Author(s) -
Murakami Kazunari,
Okimoto Tadayoshi,
Kodama Masaaki,
Sato Ryugo,
Miyajima Hajime,
Ono Masami,
Inoue Kunimitsu,
Watanabe Koichiro,
Otsu Satoshi,
Fujioka Toshio
Publication year - 2006
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/j.1523-5378.2006.00435.x
Subject(s) - lansoprazole , famotidine , metronidazole , amoxicillin , clarithromycin , helicobacter pylori , proton pump inhibitor , medicine , rabeprazole , pharmacology , gastroenterology , antibiotics , microbiology and biotechnology , biology
Background: Proton pump inhibitor–amoxicillin–metronidazole is recommended as second‐line Helicobacter pylori therapy in Japan. The authors assessed the efficacy and safety of second‐line eradication using the H 2 ‐receptor antagonist famotidine as a substitute for proton pump inhibitor. Materials and methods: Sixty‐one patients who failed in first‐line H. pylori eradication using proton pump inhibitor–clarithromycin–amoxicillin were randomly assigned to either second‐line therapy including metronidazole: a 7‐day course of lansoprazole 30 mg, amoxicillin 750 mg, and metronidazole 250 mg, b.i.d. (lansoprazole group); or a 7‐day course of famotidine 40 mg, amoxicillin 750 mg, and metronidazole 250 mg, b.i.d. (famotidine group). Eradication was assessed for each group at least 4 weeks after completing eradication therapy. Drug susceptibility test was performed using 57 strains in pretreatment to clarithromycin, metronidazole, and amoxicillin. Results: Prior to second‐line H. pylori eradication, the rate of resistance to clarithromycin was high at 84% (48/57). Similarly, resistance to metronidazole was low at 5.3% (3/57); however, no amoxicillin‐resistant strains were found. The eradication rates for both lansoprazole and famotidine treatment groups were high at 97% (29/30) and 94% (29/31), respectively. Conclusions: Famotidine treatment including metronidazole–amoxicillin as second‐line therapy provided a high eradication rate similar to lansoprazole therapy. Famotidine is therefore expected to serve as a useful H . pylori eradication regimen in patients with proton pump inhibitor allergy, an economic benefit in terms of reduced health‐care costs is also anticipated.