Re-treatment after Helicobacter pylori eradication failure.
Aim Currently, highly effective Helicobacter pylori eradication therapies are used, and although eradication failures still appear in a considerable proportion of cases, the therapeutic efficacy in such refractory cases has been only exceptionally studied.
Therefore, our aim was to evaluate the appropriate attitude when eradication therapy fails.
Methods In 127 duodenal ulcer patients, several therapies with omeprazole (O) plus one or two antibiotics [amoxycillin (A), clarithromycin (C), metronidazole (M) ] had failed to eradicate H. pylori.
Re-treatment was administered depending on initial therapy ; in no case was the same regimen repeated, and antibiotics with resistance risk (as C or M) were only re-administered using combination regimens with bismuth (B) : O+A+C+B (when C was re-administered) and O+bismuth triple therapy (BTT) (when M was re-administered).
Conclusion BTT re-treatment in O+A failure achieves a relatively low eradication rate, probably lower than BTT for the first time, suggesting that other regimens should be tried.
The following re-treatments are recommended in H. pylori eradication failure :
in O+A failure,
BTT (or O+BTT, as BTT re-treatment could be less effective than the initial BTT treatment) ;
in O+C failure,
in O+A+C failure,
in O+A+M failure,
and, finally, in O+C+M failure,
O+BTT (or O+A+C+B).
Mots-clés Pascal : Ulcère, Duodénum, Eradication, Helicobacter pylori, Spirillaceae, Spirillales, Bactérie, Echec, Evaluation, Retraitement, Conduite à tenir, Résultat, Homme, Appareil digestif pathologie, Intestin pathologie, Bactériose, Infection
Mots-clés Pascal anglais : Ulcer, Duodenum, Eradication, Helicobacter pylori, Spirillaceae, Spirillales, Bacteria, Failure, Evaluation, Reprocessing, Clinical management, Result, Human, Digestive diseases, Intestinal disease, Bacteriosis, Infection
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 99-0477256
Code Inist : 002B02H. Création : 22/03/2000.