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Impact of Quadruple Regimen of Clarithromycin Added to Metronidazole‐Containing Triple Therapy Against Helicobacter pylori Infection Following Clarithromycin‐Containing Triple‐Therapy Failure
Author(s) -
Ueki Nobue,
Miyake Kazumasa,
Kusunoki Masafumi,
Shindo Tomotaka,
Kawagoe Tetsuro,
Futagami Seiji,
Tsukui Taku,
Inagaki Hirofumi,
Sakamoto Choitsu
Publication year - 2009
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.1523-5378.2009.00664.x
Subject(s) - clarithromycin , metronidazole , regimen , amoxicillin , helicobacter pylori , medicine , gastroenterology , proton pump inhibitor , urea breath test , antibiotics , helicobacter pylori infection , surgery , microbiology and biotechnology , biology
Background: The establishment of an optimal second‐line regimen for Helicobacter pylori infection is required. Although quadruple therapy should overcome resistance to either clarithromycin or metronidazole, the effects of a quadruple regimen in second‐line therapy are unknown. This study aims to evaluate the efficacy of triple therapy composed of proton pump inhibitor/amoxicillin plus metronidazole with the combined additive effects of clarithromycin as a second‐line quadruple therapy against H. pylori infection. Materials and Methods: Participants were 104 patients in whom first‐line therapy containing proton pump inhibitor‐amoxicillin‐clarithromycin failed. Before starting second‐line therapy, patients underwent endoscopy to obtain H. pylori strain for antibiotic susceptibility tests. Patients were randomized to receive rabeprazole (10 mg), amoxicillin (750 mg), and metronidazole (250 mg), either with clarithromycin (200 mg; RAMC group) or without (RAM group); all treatments were administered twice daily for 7 days. H. pylori eradication was confirmed by 13 C‐urea breath tests performed 2 to 3 months post‐therapy. Results: As shown by intention‐to‐treat/per‐protocol analyses, the cure rates for H. pylori infection were 88.5%/93.9% and 82.7%/84.3% for the RAMC and RAM groups. Although the study probably had an insufficient power to show a significant difference between the cure rates of the two regimens, the eradication rates showed a clear trend in favor of the RAMC group. There were no severe side‐effects in any group. Conclusions: In Japan, the RAMC regimen is thought to be a promising alternative strategy for second‐line eradication of H. pylori infection.