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Helicobacter pylori first-line treatment and rescue options in patients allergic to penicillin.

Abstract：

BACKGROUND:Helicobacter pylori eradication is a challenge in patients allergic to penicillin, especially those who have failed a first-eradication trial. AIM:To assess the efficacy and tolerability of H. pylori first-line treatment and rescue options in patients allergic to penicillin. METHODS:Prospective single centre study including 40 consecutive treatments administered to patients allergic to penicillin. Therapy regimens: First-line (12 patients) omeprazole, clarithromycin and metronidazole for 7 days; second-line (17 patients) ranitidine bismuth citrate, tetracycline and metronidazole for 7 days; third-line (nine patients) rifabutin, clarithromycin and omeprazole for 10 days; and fourth-line (two patients) levofloxacin, clarithromycin and omeprazole for 10 days. OUTCOME VARIABLE:a negative (13)C-urea breath test 8 weeks after completion of treatment. RESULTS:Per-protocol/intention-to-treat eradication rates were: first-line (64/58%); second-line (ranitidine bismuth citrate; 53/47%); third-line (rifabutin; 17/11%) and fourth-line regimen (levofloxacin; 100/100%). Compliance with treatment was generally good, except with the rifabutin-based regimen, which presented adverse effects in 89% of the patients, including four cases of myelotoxicity. CONCLUSIONS:H. pylori-infected patients who are allergic to penicillin may be treated with a first-line treatment combining a proton-pump inhibitor, clarithromycin and metronidazole. Rescue options may include a regimen with ranitidine bismuth citrate, tetracycline and metronidazole. A levofloxacin-based rescue regimen (with proton-pump inhibitor and clarithromycin) may also represent an alternative, even when two or more consecutive eradication treatments have previously failed. However, rifabutin + clarithromycin + proton-pump inhibitor regimen is ineffective and poorly tolerated.

journal_name

Aliment Pharmacol Ther

journal_title

Alimentary pharmacology & therapeutics

authors

Gisbert JP,Gisbert JL,Marcos S,Olivares D,Pajares JM

doi

10.1111/j.1365-2036.2005.02687.x

subject

Has Abstract

pub_date

2005-11-15 00:00:00

pages

1041-6

issue

eissn

0269-2813

issn

1365-2036

pii

APT2687

journal_volume

pub_type

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Helicobacter pylori first-line treatment and rescue options in patients allergic to penicillin.