Korean J Gastroenterol.  2018 Apr;71(4):196-203. 10.4166/kjg.2018.71.4.196.

The Efficacy of Bismuth-containing Quadruple Therapy after Moxifloxacin-based Sequential Therapy Failure in Helicobacter pylori Eradication

• Kwon S
• Lee DH
• Kang JB
• Kim N
• Park YS
• Shin CM
• Yoon H
• Choi YJ

• KMID: 2409888
• DOI: http://doi.org/10.4166/kjg.2018.71.4.196

Abstract

BACKGROUND/AIMS
Moxifloxacin-based sequential therapy showed an excellent eradication rate as the first line treatment of Helicobacter pylori (H. pylori) infection. However, to the best of our knowledge, there were only a few studies on the treatment of those with failed moxifloxacin-based sequential therapy. Hence, this study was to investigate the efficacy of bismuth-containing quadruple therapy in those with failed moxifloxacin-based sequential or reverse sequential therapy for H. pylori eradication.
METHODS
Between January 2013 and March 2016, we retrospectively analyzed patients who failed to eradicate H. pylori using moxifloxacin-based sequential (rabeprazole 20 mg bid and amoxicillin 1 g bid for 5-7 days, followed by rabeprazole 20 mg bid, metronidazole 500 mg bid, and moxifloxacin 400 mg qd for 5-7 days) and 10 days moxifloxacin-based reverse sequential therapy as the first line treatment. Then we investigated the eradication rates of bismuth-containing quadruple therapy as the second line treatment. All subjects had no history of H. pylori eradication before. Eradication rates were described as intention-to-treat (ITT) and per-protocol (PP) analyses. H. pylori status was evaluated by 13C-urea breath test 6 weeks after the end of the treatment. Moreover, we examined any side effects that caused discontinuation of therapy.
RESULTS
Twenty-three patients received bismuth-containing quadruple therapy as the second line treatment. The overall eradication rates by ITT and PP analyses were 60.87% (n=14/23) and 73.68% (n=14/19). All the patients showed good compliance, and there were no serious adverse events.
CONCLUSIONS
Bismuth-containing quadruple therapy is insufficient as the second line eradication treatment after a failed attempt of moxifloxacin-based sequential or reverse sequential therapy. Large-scale clinical trials should be performed to establish better clinical evidence.

Keyword

Helicobacter pylori; Therapy; Bismuth

MeSH Terms

Amoxicillin
Bismuth
Breath Tests
Compliance
Helicobacter pylori*
Helicobacter*
Humans
Metronidazole
Rabeprazole
Retrospective Studies
Amoxicillin
Bismuth
Metronidazole

Figure

• 

  Fig. 1. Comparison of eradication rates according to the first line therapy. Eradication rates are presented by intention-to-treat (ITT) and per-protocol (PP) analyses. There was no statistically significant difference according to the first line therapy by both ITT (p-value= 0.257) and PP analyses (p-value=0.278). A, 10 days sequential; B, 14 days sequential; C, reverse sequential.

Reference

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