Helicobacter pylori eradication in Western Australia using novel quadruple therapy combinations
Article first published online: 16 OCT 2012
© 2012 Blackwell Publishing Ltd
Alimentary Pharmacology & Therapeutics
Volume 36, Issue 11-12, pages 1076–1083, December 2012
How to Cite
Tay, C. Y., Windsor, H. M., Thirriot, F., Lu, W., Conway, C., Perkins, T. T. and Marshall, B. J. (2012), Helicobacter pylori eradication in Western Australia using novel quadruple therapy combinations. Alimentary Pharmacology & Therapeutics, 36: 1076–1083. doi: 10.1111/apt.12089
- Issue published online: 7 NOV 2012
- Article first published online: 16 OCT 2012
- Manuscript Revised: 26 SEP 2012
- Manuscript Accepted: 26 SEP 2012
- Manuscript Revised: 5 JUN 2012
- Manuscript Received: 17 MAY 2012
- NHMRC. Grant Number: 572723
Helicobacter pylori eradication rates with standard triple therapy are declining worldwide. The optimal management of H. pylori is evolving and new treatment combinations for antibiotic resistant H. pylori strains are required, especially for patients with penicillin allergy.
To review the effectiveness of alternative antibiotic combinations and necessity of pre-antibiotic sensitivity testing.
A total of 310 consecutive patients who had failed at least one course of standard 7-day triple therapy initially prescribed by their physicians were included in this study between year 2007 and 2011. Antibiotics were prescribed based on pre-antibiotic sensitivity tests and, if any, patient's allergy to penicillin.
In 98.7% of the patients' samples, H. pylori was successfully cultured. The proportion resistant to clarithromycin and metronidazole was 94.1% and 67.6% respectively, with 65% resistant to both. For the in-house primary quadruple therapy, with Proton pump inhibitor, Amoxicillin, Rifabutin and Ciprofloxacin (PARC), H. pylori was successfully eradicated in 95.2% of patients. For patients allergic to amoxicillin, an alternative quadruple therapy using Proton pump inhibitor, Bismuth subcitrate, Rifabutin and Ciprofloxacin (PBRC) gave an eradication rate of 94.2%. Patients needing alternative salvage therapy were given novel personalised combinations consisting of bismuth, rifabutin, tetracycline or furazolidone; the eradication rate was 73.8%.
Patients who present with antibiotic resistant H. pylori can be confidently treated with PARC, PBRC or other personalised salvage therapies. These regimens can be used when treatment options are limited by penicillin allergy. Pre-treatment H. pylori antibiotic sensitivity tests contributed to the high eradication rate in this study.