Efficacy of Proton Pump Inhibitor-based Quadruple Therapy as a Rescue Treatment of <i>Helicobacter pylori </i>Infection

Original Article

The Korean Journal of Helicobacter and Upper Gastrointestinal Research 2004;4(2):47-52.
Published online December 30, 2004.

Efficacy of Proton Pump Inhibitor-based Quadruple Therapy as a Rescue Treatment of Helicobacter pylori Infection

일차 제균에 실패한 Helicobacter pylori 감염 환자에서 프로톤 펌프 억제제 중심의 사제 병합 요법의 효과

이 혁·심상군*·김재준

성균관대학교 의과대학 삼성서울병원 내과학교실, *마산삼성병원 내과학교실

Abstract

Background/Aims: Omeprazole and newly developed proton pump inhibitors(PPIs) have different pharmacokinetic characteristics. We retrospectively evaluated the effect of different PPIs on the second-line PPI-based quadruple therapy and identified factors leading to failure of this therapy. Methods: The study population included 179 patients with a failure of the first attempt to eradicate Helicobacter pylori infection using a PPI-based triple therapy(PPI, amoxicillin and clarithromycin). The patients were treated using one of the following four regimens. Three were one-week PPI-based quadruple regimens, including one of three PPIs(omeprazole 20 mg b.d. or rabeprazole 10 mg b.d. or esomeprazole 20 mg b.d.) in combination with tripotassium dicitrato bismuthate 120 mg q.d.s., metronidazole 500 mg t.d.s, and tetracycline 500 mg q.d.s(OBMT1, RBMT1, and EBMT1 group, respectively). The fourth regimen was composed of the same drug for EBMT1 group, but the duration was 2 weeks(EBMT2 group). Four to six weeks after completing rescue treatment, ¹³C-urea breath test was repeated. Results: The eradication rate of OBMT1 group(67.7%) was significantly lower than those of RBMT1(94.7%) and EBMT1 group(91.5%)(p=0.002, AVONA test). In patients with esomeprazole-based quadruple therapy, H. pylori was eradicated in 91.5% by one-week treatment(EBMT1 group), and 94.9% by two-week treatment(EBMT2 group)(p=0.529). In multivariate analysis, both smoking and type of PPI were independently significant factors for treatment failure(p=0.035 and p=0.003, respectively). Conclusions: Esomeprazole- or rabeprazole-based quadruple regimens were superior to omeprazole-based quadruple regimen as a second-line treatment for H. pylori infection. (The Korean Journal of Helicobacter and Upper Gastrointestinal Research 2004;4:47-52)

Key Words: Helicobacter pylori, Treatment failure, Proton pump inhibitors, Quadruple therapy