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The Korean Journal of Helicobacter  and Upper Gastrointestinal Research 2007;7(1):1-7.
Published online June 1, 2007.
The Rescue Therapy in the Helicobacter pylori Treatment Failure
Helicobacter pylori 제균요법에 있어서 3차요법
김나영
서울대학교 의과대학 내과학교실, 분당서울대학교병원 내과
Abstract
Helicobacter pylori (H. pylori) is a major cause of chronic gastritis, peptic ulcers, and gastric malignancies. Consequently, great emphasis has been placed on its successful eradication. One week regimen of proton pump inhibitor (PPI)- clarithromycin-amoxicillin triple therapy showed eradication rate of 71.2% by intention-to-treat analysis and 83.6% by per-protocol analysis in the recent multi-center trial in Korea, requiring rescue regimen in case of treatment failures. Currently, the internationally recommended salvage therapy for H. pylori infection is a bismuth-based quadruple drug regimen consisting of a proton pump inhibitor (PPI), bismuth salt, metronodazole, and tetracycline for a minimum of 7 days. However, a recent pooled analysis of trials which evaluated this regimen as a salvage therapy for persistent H. pylori infection demonstrated a treatment failure rate of nearly 25% and even higher rates of treatment failure in some countries, which included Korea. The main cause of this is believed to involve resistance to metronidazole. In addition, poor patient compliance due to considerable side effect rates and complicated dosing schedules is obviously also another cause. For this reason, more effective, simpler and better tolerated regimens are needed. There are only a few kinds of rescue trials after two times of H. pylori eradication failures including levofloxacin or moxifloxacin-based triple therapy, and rifabutin-based triple therapy. In any case antibiotic resistance rate is key point determining the efficacy of salvage treatment, thus the clinician had better consider the possibility of failure in the first trial of H. pylori eradication and save the antibiotics for the second or third time rescue therapy. In addition, regional or institutional difference of antibiotic resistance of H. pylori strains should be understood in the comprehensive approach of H. pylori eradication. (The Korean Journal of Helicobacter and Upper Gastrointestinal Research 2007;7:1-7)
Key Words: Helicobacter pylori, Eradication, Rescue therapy


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