Empirical rescue therapy after H. pylori treatment failure. A 10-year single centre study of 500 patients. [Aliment Pharmacol Ther] Journal article

AIM: To evaluate the efficacy of different "rescue" therapies empirically prescribed during 10 years to 500 patients in whom at least one eradication regimen had failed to cure H. pylori infection.
METHODS:
Design: Prospective single-center study.
Patients: Consecutive patients in whom at least one eradication regimen had failed. Intervention: Rescue regimens included: 1) Quadruple therapy with omeprazole-bismuth-tetracycline-metronidazole; 2) ranitidine bismuth citrate-tetracycline-metronidazole; 3) omeprazole-amoxicillin-levofloxacin; and 4) omeprazole-amoxicillin-rifabutin. Antibiotic susceptibility was unknown (rescue regimens were chosen empirically). Outcome: Eradication was defined as a negative (13)C-urea breath test 4-8 weeks after completing therapy.
RESULTS: Five-hundred patients were included (76% functional dyspepsia, 24% peptic ulcer). Compliance with 1(st), 2(nd) and 3(rd)-line regimens was 92%, 92%, and 95%. Adverse effects were reported by 30%, 37%, and 55% of the patients receiving 2(nd), 3(rd), and 4(th)-line regimens. Overall, H. pylori cure rates with the 2(nd), 3(rd), and 4(th)-line rescue regimens were 70%, 74%, and 76%. Cumulative H. pylori eradication rate with 4 successive treatments was 99.5%.
CONCLUSION: It is possible to construct an overall treatment strategy to maximize H. pylori eradication, based on the administration of four consecutive empirical regimens; thus, performing bacterial culture even after a second or third eradication failure may not be necessary.

Aliment Pharmacol Ther