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Aliment Pharmacol Ther. 2005 Nov 15;22(10):1041-6.

Helicobacter pylori first-line treatment and rescue options in patients allergic to penicillin.

Author information

1
Department of Gastroenterology, La Princesa University Hospital, Madrid, Spain. gisbert@meditex.es

Abstract

BACKGROUND:

Helicobacter pylori eradication is a challenge in patients allergic to penicillin, especially those who have failed a first-eradication trial.

AIM:

To assess the efficacy and tolerability of H. pylori first-line treatment and rescue options in patients allergic to penicillin.

METHODS:

Prospective single centre study including 40 consecutive treatments administered to patients allergic to penicillin. Therapy regimens: First-line (12 patients) omeprazole, clarithromycin and metronidazole for 7 days; second-line (17 patients) ranitidine bismuth citrate, tetracycline and metronidazole for 7 days; third-line (nine patients) rifabutin, clarithromycin and omeprazole for 10 days; and fourth-line (two patients) levofloxacin, clarithromycin and omeprazole for 10 days.

OUTCOME VARIABLE:

a negative (13)C-urea breath test 8 weeks after completion of treatment.

RESULTS:

Per-protocol/intention-to-treat eradication rates were: first-line (64/58%); second-line (ranitidine bismuth citrate; 53/47%); third-line (rifabutin; 17/11%) and fourth-line regimen (levofloxacin; 100/100%). Compliance with treatment was generally good, except with the rifabutin-based regimen, which presented adverse effects in 89% of the patients, including four cases of myelotoxicity.

CONCLUSIONS:

H. pylori-infected patients who are allergic to penicillin may be treated with a first-line treatment combining a proton-pump inhibitor, clarithromycin and metronidazole. Rescue options may include a regimen with ranitidine bismuth citrate, tetracycline and metronidazole. A levofloxacin-based rescue regimen (with proton-pump inhibitor and clarithromycin) may also represent an alternative, even when two or more consecutive eradication treatments have previously failed. However, rifabutin + clarithromycin + proton-pump inhibitor regimen is ineffective and poorly tolerated.

[Indexed for MEDLINE]
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