Triple Therapy with High‐Dose Proton‐Pump Inhibitor, Amoxicillin, and Doxycycline Is Useless for Helicobacter pylori Eradication: A Proof‐of‐Concept Study. Issue 2 (10th February 2014)

• Record Type: Journal Article
• Authors: Almeida, Nuno; Romãozinho, José M.; Donato, Maria M.; Luxo, Cristina; Cardoso, Olga; Cipriano, Maria A.; Marinho, Carol; Sofia, Carlos
• Is Part Of: Helicobacter. Volume 19:Issue 2(2014:Apr.)
• Page Start: 90
• Page End: 97
• Publication Date: 2014-02-10
• Subjects: Helicobacter -- Periodicals; Helicobacter infections -- Periodicals; Stomach -- Diseases -- Periodicals; 616.3301405
• DOI: 10.1111/hel.12106
• Languages: English
• ISSNs: 1083-4389

Abstract

<abstract abstract-type="main" id="hel12106-abs-0001"> <title>Abstract</title> <sec id="hel12106-sec-0001" sec-type="section"> <title>Introduction</title> <p> <italic>Helicobacter pylori</italic> resistance to antibiotics is steadily increasing and multidrug‐resistant strains are common and difficult to eliminate, mainly in countries where bismuth, tetracycline, furazolidone, and rifabutin are unavailable.</p> </sec> <sec id="hel12106-sec-0002" sec-type="section"> <title>Aim</title> <p>To evaluate the efficacy and safety of a triple therapy with proton‐pump inhibitor (PPI), amoxicillin, and doxycycline in patients with multidrug‐resistant <italic>H. pylori</italic>.</p> </sec> <sec id="hel12106-sec-0003" sec-type="section"> <title>Patients and Methods</title> <p>This prospective study involved 16 patients (13 females; mean age – 50 ± 11.3 years) infected by <italic>H. pylori</italic> with known resistance to clarithromycin, metronidazole, and levofloxacin, but susceptibility to amoxicillin and tetracycline. All patients were previously submitted to upper endoscopy with gastric biopsies for <italic>H. pylori</italic> culture and susceptibility testing by Etest. Mutations in 23S rRNA and gyrA genes were determined by real‐time PCR. A 10‐day eradication regimen with PPI (double‐standard dose b.i.d.), amoxicillin (1000 mg b.i.d.), and doxycycline (100 mg b.i.d.) was prescribed after pretreatment with PPI during 3 days. Eradication success was assessed by <sup>13</sup>C‐urea breath test 6–10 weeks after treatment. Compliance and adverse events were determined through phone contact immediately after treatment and specific written questionnaires.</p> </sec> <sec id="hel12106-sec-0004" sec-type="section"> <title>Results</title> <p>Only one patient did not complete treatment due to adverse events. Another four patients experienced mild side effects not affecting compliance. The control <sup>13</sup>C‐urea breath test was positive in all patients. Per‐protocol and intention‐to‐treat eradication rates were 0%.</p> </sec> <sec id="hel12106-sec-0005" sec-type="section"> <title>Conclusions</title> <p>Although safe, a triple‐therapy protocol with high‐dose PPI, amoxicillin, and doxycycline is useless for multidrug‐resistant <italic>H. pylori</italic> eradication.</p> </sec> </abstract>