Open AccessDual therapy for third-lineHelicobacter pylorieradication and urea breath test prediction
Author(s) -
Toshihiro Nishizawa,
Hidekazu Suzuki,
Taira Maekawa,
Naohiko Harada,
Tatsuya Toyokawa,
Toshio Kuwai,
Masanori Ohara,
Takahiro Suzuki,
Masahiro Kawanishi,
Kenji Noguchi,
Toshiyuki Yoshio,
Shinji Katsushima,
Hideo Tsuruta,
Eiji Masuda,
Munehiro Tanaka,
S. Katayama,
Norio Kawamura,
Yuko Nishizawa,
Toshifumi Hibi,
Masahīko Takahashi
Publication year - 2012
Publication title -
world journal of gastroenterology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.427
H-Index - 155
eISSN - 2219-2840
pISSN - 1007-9327
DOI - 10.3748/wjg.v18.i21.2735
Subject(s) - urea breath test , regimen , medicine , tolerability , rabeprazole , gastroenterology , helicobacter pylori , breath test , proton pump inhibitor , clarithromycin , adverse effect , amoxicillin , metronidazole , surgery , antibiotics , helicobacter pylori infection , biology , microbiology and biotechnology
We evaluated the efficacy and tolerability of a dual therapy with rabeprazole and amoxicillin (AMX) as an empiric third-line rescue therapy. In patients with failure of first-line treatment with a proton pump inhibitor (PPI)-AMX-clarithromycin regimen and second-line treatment with the PPI-AMX-metronidazole regimen, a third-line eradication regimen with rabeprazole (10 mg q.i.d.) and AMX (500 mg q.i.d.) was prescribed for 2 wk. Eradication was confirmed by the results of the ¹³C-urea breath test (UBT) at 12 wk after the therapy. A total of 46 patients were included; however, two were lost to follow-up. The eradication rates as determined by per-protocol and intention-to-treat analyses were 65.9% and 63.0%, respectively. The pretreatment UBT results in the subjects showing eradication failure; those patients showing successful eradication comprised 32.9 ± 28.8 permil and 14.8 ± 12.8 permil, respectively. The pretreatment UBT results in the subjects with eradication failure were significantly higher than those in the patients with successful eradication (P = 0.019). A low pretreatment UBT result (≤ 28.5 permil) predicted the success of the eradication therapy with a positive predictive value of 81.3% and a sensitivity of 89.7%. Adverse effects were reported in 18.2% of the patients, mainly diarrhea and stomatitis. Dual therapy with rabeprazole and AMX appears to serve as a potential empirical third-line strategy for patients with low values on pretreatment UBT.