文摘
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 13C-urea-breath-test 4-?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?60-4?%) and 65?% (58-2?%). 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.