Efficacy of Quadruple Therapy Containing Amoxicillin-clavulanate and Tetracycline for the Treatment of <em>Helicobacter pylori</em> Infection Based on Antimicrobial Susceptibility Testing

Original

The Korean Journal of Helicobacter and Upper Gastrointestinal Research 2005;5(2):157-162.
Published online December 3, 2005.

Efficacy of Quadruple Therapy Containing Amoxicillin-clavulanate and Tetracycline for the Treatment of Helicobacter pylori Infection Based on Antimicrobial Susceptibility Testing

Helicobacter pylori 감염 치료를 위한 Amoxicillin-clavulanate과 Tetracycline 포함 사제요법의 항생제 감수성 검사를 통한 제균 효과 분석

천재희·김상균·김정목*·김나영^†·이동호^†·김주성·정현채·송인성

서울대학교 의과대학 내과학교실, 간연구소, 한양대학교 의과대학 미생물학교실, 의과학연구소*, 분당서울대학교병원 내과^†

Abstract

Background/Aims: To evaluate the efficacy and tolerability of amoxicillin-clavulanate and tetracycline-based quadruple therapy as an alternative second-line treatment for Helicobacter pylori (H. pylori). Methods: The study subjects consisted of 54 patients infected with H. pylori, in whom initial triple therapy had failed. Subjects were randomized to receive the following 7-day therapies: (1) pantoprazole 40 mg bid, tripotassium dicitrate bismuthate 300 mg qid, amoxicillin- clavulanate 1,000 mg bid, and tetracycline 500 mg qid (PBAT), or (2) pantoprazole 40 mg bid, tripotassium dicitrate bismuthate 300 mg qid, metronidazole 500 mg tid, and tetracycline 500 mg qid (PBMT). Eradication rates based on antibiotic susceptibility, drug compliance and side effect rates were evaluated and compared. Results: The H. pylori eradication rates were 16.0%/17.4% with PBAT and 65.5%/70.4% with PBMT by intention-to-treat (p＜0.001) and per-protocol analyses (p＜0.001), respectively. In patients that received PBAT, the eradication rates were only 16.7% (2/12) for both amoxicillin and tetracycline-susceptible H. pylori strains. Drug compliance and side effect rates were similar in the two groups. Conclusions: Despite high individual in vitro antimicrobial activity, amoxicillin-clavulanate and tetracycline-based quadruple therapy showed low eradication rates, which strongly suggests that it should not be considered as a therapeutic option for H. pylori eradication. (The Korean Journal of Helicobacter and Upper Gastrointestinal Research 2005;5:157-163)

Key Words: Helicobacter pylori, Amoxicillin-clavulanate, Tetracycline, Quadruple