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Medline ® Abstract for Reference 49

of 'Treatment regimens for Helicobacter pylori'

49
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Second-line treatment for failure to eradicate Helicobacter pylori: a randomized trial comparing four treatment strategies.
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Lamouliatte H, Mégraud F, Delchier JC, Bretagne JF, Courillon-Mallet A, De Korwin JD, Fauchère JL, Labigne A, Fléjou JF, Barthelemy P, Multicentre Study Group
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Aliment Pharmacol Ther. 2003;18(8):791.
 
AIM: To compare the efficacy of different regimens in patients in whom previous Helicobacter pylori eradication therapy has failed.
METHODS: In this study named StratHegy patients (n=287) were randomized to receive one of three empirical triple therapy regimens or a strategy based on antibiotic susceptibility. The empirical regimens were omeprazole, 20 mg b.d., plus amoxicillin, 1000 mg b.d., and clarithromycin, 500 mg b.d., for 7 days (OAC7), clarithromycin, 500 mg b.d., for 14 days (OAC14) or metronidazole, 500 mg b.d., for 14 days (OAM14). In the susceptibility-based strategy, patients with clarithromycin-susceptible strains received OAC14, whilst the others received OAM14. The 13C-urea breath test was performed before randomization and 4-5 weeks after eradication therapy.
RESULTS: In the intention-to-treat analysis, the eradication rates for empirical therapies were as follows: OAC7, 47.4% (27/57); OAC14, 34.5% (20/58); OAM14, 63.2% (36/57); it was 74.3% (84/113) for thesusceptibility-based treatment (P<0.01 when compared with OAC7 and OAC14). In patients receiving clarithromycin, the eradication rates were 80% for clarithromycin-susceptible strains and 16% for clarithromycin-resistant strains; in patients receiving OAM14, the eradication rates were 81% for metronidazole-susceptible strains and 59% for metronidazole-resistant strains.
CONCLUSIONS: Eradication rates of approximately 75% can be achieved with second-line triple therapy based on antibiotic susceptibility testing. If susceptibility testing is not available, OAM14 is an appropriate alternative.
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Service des Maladies de l' Appareil Digestif, Hôpital St André, Bordeaux, France.
PMID