Randomized Comparison of Two Non-Bismuth-Containing Second-line Rescue Therapies for Helicobacter pylori
Chuah SK et al. – Despite low in vitro drug resistances to amoxicillin and tetracycline, the efficacy of 14–day EAT regimens attained an unacceptable report card of 75% eradication rates in intention–to–treat analysis and was not even superior to the 7–day esomeprazole/amoxicillin/levofloxacin (EAL) regimen. Drug–drug interaction between combined antibiotics should be considered other than in vivo drug resistances.Methods
- One hundred and twenty-eight patients who failed H. pylori eradication using the standard triple therapy for 7 days are randomly assigned to either EAL group (esomeprazole 40 mg twice daily, amoxicillin 1 g twice daily, and levofloxacin 500 mg once daily) for 7 days or EAT group (esomeprazole 40 mg twice daily, amoxicillin 1 g twice daily, tetracycline 500 mg four times daily) for 14 days.
- Follow-up endoscopy or urea breath test was performed 8 weeks later to assess treatment response.
- The eradication rates of EAL and EAT groups were 78.1 versus 75.0%, p = .676 (in intention-to-treat analysis) and 80.3 versus 80%, p = .0964 (per-protocol analysis).
- Both groups exhibited similar drug compliance (95.3 vs 96.9%, p = .952) but more adverse events in the EAT group (6.3 vs 12.5%, p = .225).