The Efficacy of Sequential Therapy as Second Line Therapy for Refractory Helicobacter Pylori Infection - A Pilot Study
Status:
Completed
Trial end date:
2010-12-01
Target enrollment:
Participant gender:
Summary
Helicobacter pylori infection has been shown to be associated with the development of gastric
cancer and peptic ulcer diseases. Eradication of H. pylori infection could reduce the
occurence or recurrence of these diseases. However, it was estimated that 15-20% of patients
would fail from first line standard eradication therapy and need second line rescue therapy.
About 15-30% of patient would fail from second line therapy and need to be rescued with third
line therapy. The commonly used salvage regimens include:
1. Bismuth based quadruple therapy (combined with ranitidine or proton-pump inhibitor (PPI)
plus two antibiotics)
2. Levofloxacin or moxifloxacin or rifabutin based triple therapy.
However, Bismuth is not available in many countries and the administration method is complex.
Its usage is limited by the high pill number and low compliance rate. In recent years, the
concept of sequential therapy has been advocated in the treatment of H. pylori infection. The
regimen includes a PPI plus amoxicillin for five days, followed by a PPI plus clarithromycin
and metronidazole for another five days. The eradication rate in the first line treatment of
sequential therapy had been reported to be as high as 90%. More importantly, it has been
demonstrated that the eradication rate among patients with clarithromycin-resistant strains
could be as high as 89%.
Aims: Therefore, the investigators aim to assess the efficacy of levofloxacin-based
sequential therapy as second line therapy for those who fail from one standard eradication
therapy.