PMID- 24126798
OWN - NLM
STAT- MEDLINE
DCOM- 20140410
LR  - 20211021
IS  - 1573-2568 (Electronic)
IS  - 0163-2116 (Linking)
VI  - 59
IP  - 2
DP  - 2014 Feb
TI  - Third-line rescue therapy with bismuth-containing quadruple regimen after failure 
      of two treatments (with clarithromycin and levofloxacin) for H. pylori infection.
PG  - 383-9
LID - 10.1007/s10620-013-2900-x [doi]
AB  - BACKGROUND: Helicobacter pylori eradication therapy with a proton pump inhibitor 
      (PPI), clarithromycin, and amoxicillin fails in >20 % of cases. A rescue therapy 
      with PPI-amoxicillin-levofloxacin still fails in >20 % of patients. AIM: To 
      evaluate the efficacy and tolerability of a bismuth-containing quadruple regimen 
      in patients with two consecutive eradication failures. METHODS: Prospective 
      multicenter study of patients in whom 1st treatment with 
      PPI-clarithromycin-amoxicillin and 2nd with PPI-amoxicillin-levofloxacin had 
      failed. A 3rd eradication regimen with a 7- to 14-day PPI (standard dose b.i.d.), 
      bismuth subcitrate (120 mg q.i.d. or 240 mg b.i.d.), tetracycline (from 250 mg 
      t.i.d. to 500 mg q.i.d.) and metronidazole (from 250 mg t.i.d. to 500 mg q.i.d.). 
      Eradication was confirmed by (13)C-urea-breath-test 4-8 weeks after therapy. 
      Compliance was determined through questioning and recovery of empty medication 
      envelopes. Adverse effects were evaluated by means of a questionnaire. RESULTS: 
      Two hundred patients (mean age 50 years, 55 % females, 20 % peptic ulcer/80 % 
      uninvestigated-functional dyspepsia) were initially included, and two were lost 
      to follow-up. In all, 97 % of patients complied with the protocol. Per-protocol 
      and intention-to-treat eradication rates were 67 % (95 % CI 60-74 %) and 65 % 
      (58-72 %). Adverse effects were reported in 22 % of patients, the most common 
      being nausea (12 %), abdominal pain (11 %), metallic taste (8.5 %), and diarrhea 
      (8 %), none of them severe. CONCLUSION: A bismuth-containing quadruple regimen is 
      an acceptable third-line strategy and a safe alternative after two previous H. 
      pylori eradication failures with standard clarithromycin- and 
      levofloxacin-containing triple therapies.
FAU - Gisbert, J P
AU  - Gisbert JP
AD  - Gastroenterology Unit, Hospital Universitario de La Princesa and Instituto de 
      Investigacion Sanitaria Princesa (IP), Playa de Mojacar 29. Urb. Bonanza., 28669, 
      Boadilla del Monte, Madrid, Spain, gisbert@meditex.es.
FAU - Perez-Aisa, A
AU  - Perez-Aisa A
FAU - Rodrigo, L
AU  - Rodrigo L
FAU - Molina-Infante, J
AU  - Molina-Infante J
FAU - Modolell, I
AU  - Modolell I
FAU - Bermejo, F
AU  - Bermejo F
FAU - Castro-Fernandez, M
AU  - Castro-Fernandez M
FAU - Anton, R
AU  - Anton R
FAU - Sacristan, B
AU  - Sacristan B
FAU - Cosme, A
AU  - Cosme A
FAU - Barrio, J
AU  - Barrio J
FAU - Harb, Y
AU  - Harb Y
FAU - Gonzalez-Barcenas, M
AU  - Gonzalez-Barcenas M
FAU - Fernandez-Bermejo, M
AU  - Fernandez-Bermejo M
FAU - Algaba, A
AU  - Algaba A
FAU - Marin, A C
AU  - Marin AC
FAU - McNicholl, A G
AU  - McNicholl AG
CN  - H. pylori Study Group of the Spanish Gastroenterology Association
LA  - eng
PT  - Clinical Trial
PT  - Journal Article
PT  - Multicenter Study
PT  - Research Support, Non-U.S. Gov't
DEP - 20131015
PL  - United States
TA  - Dig Dis Sci
JT  - Digestive diseases and sciences
JID - 7902782
RN  - 0 (Anti-Bacterial Agents)
RN  - 0 (Organometallic Compounds)
RN  - 0 (Proton Pump Inhibitors)
RN  - 140QMO216E (Metronidazole)
RN  - 6GNT3Y5LMF (Levofloxacin)
RN  - 804826J2HU (Amoxicillin)
RN  - F8VB5M810T (Tetracycline)
RN  - H1250JIK0A (Clarithromycin)
RN  - HS813P8QPX (bismuth tripotassium dicitrate)
SB  - IM
MH  - Adult
MH  - Amoxicillin/therapeutic use
MH  - Anti-Bacterial Agents/adverse effects/*therapeutic use
MH  - Clarithromycin/*therapeutic use
MH  - Drug Therapy, Combination
MH  - Female
MH  - Helicobacter Infections/diagnosis/*drug therapy/microbiology
MH  - Helicobacter pylori/*drug effects/isolation & purification
MH  - Humans
MH  - Levofloxacin/*therapeutic use
MH  - Male
MH  - Metronidazole/therapeutic use
MH  - Middle Aged
MH  - Organometallic Compounds/adverse effects/*therapeutic use
MH  - Prospective Studies
MH  - Proton Pump Inhibitors/therapeutic use
MH  - *Salvage Therapy
MH  - Spain
MH  - Surveys and Questionnaires
MH  - Tetracycline/therapeutic use
MH  - Time Factors
MH  - Treatment Failure
EDAT- 2013/10/16 06:00
MHDA- 2014/04/11 06:00
CRDT- 2013/10/16 06:00
PHST- 2013/07/08 00:00 [received]
PHST- 2013/09/25 00:00 [accepted]
PHST- 2013/10/16 06:00 [entrez]
PHST- 2013/10/16 06:00 [pubmed]
PHST- 2014/04/11 06:00 [medline]
AID - 10.1007/s10620-013-2900-x [doi]
PST - ppublish
SO  - Dig Dis Sci. 2014 Feb;59(2):383-9. doi: 10.1007/s10620-013-2900-x. Epub 2013 Oct 
      15.