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document
Effectiveness of two quadruple , tetracycline- or clarithromycin-containing , second-line , Helicobacter pylori eradication therapies . BACKGROUND There are no guidelines on second-line therapies for Helicobacter pylori eradication failures of omeprazole-clarithromycin-amoxicillin triple therapy . AIM To compare the efficacy of two second-line therapies for persistent H. pylori infection . METHODS Over a 6-year period , patients with persistent H. pylori infection following omeprazole-clarithromycin-amoxicillin eradication therapy were randomized to receive omeprazole , 20 mg twice daily , bismuth , 120 mg four times daily , metronidazole , 500 mg twice daily , and either tetracycline , 500 mg four times daily , or clarithromycin , 500 mg twice daily , given for 7 days . Before therapy , patients underwent endoscopy with biopsies for histology , culture and antibiotic susceptibility tests . H. pylori infection was confirmed by histology . RESULTS Of the 95 randomized patients , 88 ( 93 % ) completed the study . Age , sex , smoking , ulcer/non-ulcer dyspepsia ratio and antibiotic resistance were not significantly different between the treatment groups . On intention-to-treat analysis , eradication was achieved in 41 of the 49 patients ( 84 % ; 95 % confidence interval , 70.4-92.7 % ) and 27 of the 46 patients ( 59 % ; 95 % confidence interval , 43.3-73.0 % ) of the tetracycline- and clarithromycin-containing groups , respectively ( P=0.007 ) . On multivariate regression analysis , the sensitivity of H. pylori to metronidazole had a likelihood ratio of 5.2 ( P=0.022 ) , followed by the type of quadruple therapy ( likelihood ratio , 4.4 ; P=0.036 ) . CONCLUSIONS Tetracycline-containing quadruple rescue therapy is highly effective in treating H. pylori eradication failures of the omeprazole-amoxicillin-clarithromycin regimen .
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Intervention_Pharmacological
tetracycline-
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Intervention_Pharmacological
clarithromycin-containing
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Intervention_Pharmacological
omeprazole-clarithromycin-amoxicillin
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Intervention_Pharmacological
omeprazole , 20 mg twice daily
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Intervention_Pharmacological
bismuth , 120 mg four times daily
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Intervention_Pharmacological
metronidazole , 500 mg twice daily
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Intervention_Pharmacological
tetracycline , 500 mg
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Intervention_Pharmacological
clarithromycin , 500 mg
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Intervention_Pharmacological
Tetracycline-containing quadruple rescue therapy
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Outcome_Physical
Helicobacter pylori eradication therapies
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Outcome_Other
eradication
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Outcome_Other
sensitivity of H.