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Risk factors of rescue bismuth quadruple therapy failure for Helicobacter pylori eradication
Author(s) -
Lee Jung Won,
Kim Nayoung,
Nam Ryoung Hee,
Lee Sun Min,
Soo In Choi,
Kim Jung Mogg,
Lee Dong Ho
Publication year - 2019
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/jgh.14625
Subject(s) - metronidazole , medicine , helicobacter pylori , esomeprazole , tetracycline , adverse effect , gastroenterology , drug resistance , antibiotics , microbiology and biotechnology , biology
Background and Aim Failure of bismuth quadruple therapy for Helicobacter pylori eradication is frequently observed. To increase the eradication rate, comprehensive analyses need to be performed regarding risk factors of bismuth quadruple therapy failure based on complete standard culture and antimicrobial susceptibility testing results. Methods Patients with history of failed first therapy who had H. pylori colonies isolated from culture and successful minimum inhibitory concentration (MIC) test were enrolled. Esomeprazole, bismuth, metronidazole, and tetracycline (quadruple) therapies for 7 or 14 days were given. Eradication rate, treatment compliance, adverse events, and risk factors for the failure of bismuth quadruple therapy were analyzed. Results A total 54 patients were enrolled. Overall eradication rate in the present study was 88.8%. The eradication rate for cases with metronidazole resistance such as MIC 8–16 μg/mL or 16–32 μg/mL was 92.8% (13/14). For cases with high level metronidazole resistance (MIC > 32 μg/mL), the eradication rate was only 60% (6/10). Multivariate analysis regarding compliance, treatment duration, age > 60, three kinds of metronidazole MICs, tetracycline MIC > 4 μg/mL, adverse events and any other parameters, “metronidazole resistance, high level (MIC > 32 μg/mL)” was the only independent risk factor for eradication failure ( P = 0.007). Conclusion For cases with metronidazole resistance at MIC > 32 μg/mL, rescue therapy other than bismuth‐containing quadruple therapy is needed.