Quadruple therapy best second-line treatment of H. pylori infection

Last Updated: 2017-08-02

By Reuters Staff

NEW YORK (Reuters Health) - Ten-day quadruple therapy with a proton pump inhibitor (PPI), bismuth, tetracycline and levofloxacin is better than standard levofloxacin triple therapy for the second-line treatment of Helicobacter pylori infection, researchers from Taiwan report.

H. pylori eradication rates with standard triple therapy have fallen below 80% in most countries, leading to increased adoption of non-bismuth quadruple treatments, the team notes. Even with these regimens, H. pylori eradication fails in 3% to 24% of infected patients, and how to treat these patients remains controversial.

Dr. Deng-Chyang Wu from Kaohsiung Medical University and colleagues in the Taiwan Acid-Related Disease (TARD) study group compared the efficacy of 10 days of quadruple therapy with esomeprazole-bismuth-tetracycline-levofloxacin (EBTL) versus triple therapy with esomeprazole-amoxicillin-levofloxacin (EAL) in the second-line treatment of H. pylori infection.

After an interim efficacy analysis, the independent data monitoring committee recommended termination of the trial because of the substantially lower eradication rate with EAL versus EBTL.

Eradication rates were significantly higher among the 50 patients assigned to EBTL than among the 52 patients assigned to EAL (98% vs. 69%; P<0.001), the researchers report in The American Journal of Gastroenterology, online July 18.

Eradication rates with EBTL were significantly higher than those with EAL among patients who had received standard first-line triple therapy and among patients who had received first-line non-bismuth quadruple therapies.

Adverse event rates were nominally higher in the EBTL group than in the EAL group (22.0% vs. 11.5%), but only nausea occurred significantly more often in the EBTL group (16.0% vs. 3.8%).

"Ten-day PPI-bismuth-tetracycline-levofloxacin quadruple therapy is a good option for rescue treatment of H. pylori infection after failure of standard triple or non-bismuth quadruple therapy," the researchers conclude.

Dr. Wu did not respond to a request for comment.

SOURCE: http://bit.ly/2wlrqVA

Am J Gastroenterol 2017.