High-dose rabeprazole-amoxicillin dual therapy and rabeprazole triple therapy with amoxicillin and levofloxacin for 2 weeks as first and second line rescue therapies for Helicobacter pylori treatment failures

• Published in: Alimentary pharmacology & therapeutics Vol. 35; no. 9; pp. 1097 - 1102
• Main Authors: Goh, K.-L., Manikam, J., Qua, C.-S.
• Format: Journal Article
• Language: English
• Published: Oxford Blackwell Publishing Ltd 01-05-2012; Blackwell
• Subjects: Amoxicillin - administration & dosage; Amoxicillin - therapeutic use; Anti-Bacterial Agents - administration & dosage; Anti-Bacterial Agents - therapeutic use; Bacterial diseases; Bacterial diseases of the digestive system and abdomen; Biological and medical sciences; Breath Tests; Digestive system; Drug Therapy, Combination; Follow-Up Studies; Gastroenterology. Liver. Pancreas. Abdomen; Helicobacter Infections - drug therapy; Helicobacter Infections - microbiology; Helicobacter pylori - drug effects; Helicobacter pylori - isolation & purification; Human bacterial diseases; Humans; Infectious diseases; Levofloxacin - administration & dosage; Levofloxacin - therapeutic use; Medical sciences; Pharmacology. Drug treatments; Prospective Studies; Proton Pump Inhibitors - administration & dosage; Proton Pump Inhibitors - therapeutic use; Rabeprazole - administration & dosage; Rabeprazole - therapeutic use; Treatment Failure; Treatment Outcome; Urea - metabolism; Urea - pharmacology; Levofloxacin; H; Spirillaceae; Antiulcer agent; K; Rabeprazole; Proton pump inhibitor; Penicillin derivatives; Fluoroquinolone derivatives; Helicobacter pylori; Bacteria; Second line treatment; High dose; Quinolone derivatives; Failure; Spirillales; Enzyme; β-Lactams; Enzyme inhibitor; First line treatment; Infection; Antibiotic; Benzimidazole derivatives; Amoxicillin; Bacteriosis; exchanging ATPase; Hydrolases; Antibacterial agent
• ISSN: 0269-2813; 1365-2036
• DOI: 10.1111/j.1365-2036.2012.05054.x

Summary
Background
H. pylori eradication failures are difficult to treat and rescue therapies often consist of complex treatment regimens.
Aim
To determine an effective and practical rescue therapeutic strategy for H. pylori treatment failures using two consecutive regimens: first rescue therapy ‐ rabeprazole 20 mg t.d.s. and amoxicillin 1 g t.d.s. for 2 weeks and for failures a further second rescue therapy ‐ rabeprazole 20 mg b.d., levofloxacin 500 mg b.d., amoxicillin 1 g b.d. for a further 2 weeks.
Methods
Consecutive patients who failed the proton pump inhibitor (PPI) 1‐week triple therapy were recruited for the study. H. pylori status was determined by a C13 urea breath test.
Results
One hundred and forty‐nine patients received the first rescue therapy. Seven were not compliant to medication/defaulted follow‐up. Eradication success‐ first rescue therapy: per protocol (PP) analysis‐107/142 (75.4%) (95% CI (68.3–82.4%) and intention to treat (ITT) analysis‐107/149 (71.8%) 95% CI (64.6–79.0%). Thirty‐one of 35 patients who failed the first rescue therapy received the second rescue therapy. All were compliant with medications. Eradication success‐ PP and ITT was 28/31 (90.3%) 95% CI (74.2–98.0%). The cumulative eradication rate using both rescue therapies: PP analysis‐ 135/138 (97.8%) 95% CI: (93.8–99.6%), ITT analysis‐ 135/149 (90.6%) 95% CI: (84.7–94.8%).
Conclusions
A 2‐week high dose PPI‐amoxicillin dual therapy followed by a PPI‐amoxicillin‐levofloxacin triple therapy were highly successful in achieving eradication in H. pylori treatment failures.