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KMID : 0882420080740010023
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Korean Journal of Medicine
2008 Volume.74 No. 1 p.23 ~ p.29
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Rescue therapies for Helicobacter pylori infection after failure of proton pump inhibitor-based standard triple therapy
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Seo Young-Hwan
Lee Soo-Yeon
Kim Jae-Kyu
Kim Hyung-Joon
Park Bum-Joon
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Abstract
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Background/Aims : Proton pump inhibitor (PPI)-based standard triple therapy for Helicobacter pylori infection is widely used, but it has a considerable failure rate. The aim of this study was to evaluate the efficacy and tolerability of rescue therapies with a quadruple regimen and a rifabutin-based regimen for patients who experienced failure with PPI-based standard triple therapy.
Methods : From July 2004 through October 2006, 52 patients for whom first?line triple therapy (PPI, amoxicillin and clarithromycin) had failed were included in this study. They were treated with a quadruple regimen for 7 days (PPI, bismuth, tetracycline and metronidazole) as a second?line therapy. For third?line therapy, a rifabutin-based regimen (PPI, rifabutin and amoxicillin) was prescribed for 14 days. The H. pylori status was determined before and at least 4 weeks after therapy by the 13C urea breath test or by endoscopy with antral and corpus biopsies for a rapid urease test, histological examination and culture.
Results : The mean age was 52.6 years. Thirteen patients (25%) of the 52 patients were dropped. The eradication rate of the quadruple therapy was 84.6% (33/39). Three patients of the 6 failures with quadruple therapy were then treated with the rifabutin-based regimen. The eradication rate of the rifabutin-based therapy was 100% (3/3). Adverse effects (10.2%) were reported in 4 patients who were treated with quadruple regimen.
Conclusion : The quadruple regimen is still an effective second-line therapy for Korean patients who experience failure with PPI-based standard triple therapy. The rifabutin-based regimen could be used as a third-line rescue therapy in Korea. (Korean J Med 74:23-29, 2008)
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KEYWORD
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Helicobacter pylori, Second line therapy, Rescue therapy
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