SEARCH

SEARCH BY CITATION

Sirs,

We thank Dr Tursi for his recent comments concerning our recent publication.[1, 2] Bacterial culture and standard antibiotic susceptibility testing is recommended for patients who have failed first-line triple therapy.[3] Such standard susceptibility testing is not widely available in many countries. As a result, the success of a treatment plan without standard susceptibility testing is of pertinent interest.

We are currently undertaking a retrospective analysis on the salvage therapies, PARC and PBRC (Table 1), which were prescribed to patients without performing the standard susceptibility testing. A total of 98 patients initially failed at least one course (usually two) of standard 7-day triple therapy and were subsequently treated in this study.

Table 1. Quadruple salvage therapies
PARC (Patients not allergic to penicillin)
Rabeprazole (PPI)1 × 20 mg tablet, 3 times daily for 10 days
Amoxicillin1 × 1000 mg tablet, 3 times daily for 10 days
Rifabutin1 × 150 mg tablet, 2 times daily for 5 days – starting on Day 6.
Ciprofloxacin1 × 500 mg tablet, 2 times daily for 5 days – starting on Day 6.
PBRC (Patients allergic to penicillin)
Rabeprazole (PPI)1 × 20 mg tablet, 3 times daily for 10 days
DeNol (Bismuth)2 × 120 mg tablets, 4 times daily for 10 days
Ciprofloxacin1 × 500 mg tablet, 2 times daily for 10 days
Rifabutin1 × 150 mg tablet, 2 times daily for 10 days

Preliminary analysis suggests that the PARC regimen successfully eradicated H. pylori in 90.5% of patients (= 63, 95% CI: 85–98) (Table 2). For patients allergic to amoxicillin, the PBRC regimen eradication rate was 100% (= 25, 95% CI: 88–100). Patients requiring alternative salvage therapies were given novel personalised combinations consisting of bismuth, rifabutin and either tetracycline or furazolidone; the eradication rate for this small group was 90% (= 10, 95% CI: 57–99).

Table 2. Eradication rates of the therapy prescribed
Treatment n Helicobacter pylori eradicatedSuccess rate
PARC635791%
PBRC2525100%
Personalised therapy10990%

Although the sample size is small, this encouraging analysis indicates that the PARC and PBRC salvage therapies can be confidently prescribed without the expense of standard antimicrobial susceptibility testing. The efficacies of alternative antibiotic combinations with small sample sizes are continuously being monitored in our clinic. It is important to note that antibiotic resistant profiles vary from country to country. As a result, the proposed salvage therapies in our previous publication[2], PARC and PBRC, are suitable only for countries with low rates of resistance to quinolone and rifabutin.

Acknowledgement

  1. Top of page
  2. Acknowledgement
  3. References

The authors' declarations of personal and financial interests are unchanged from those in the original article.2

References

  1. Top of page
  2. Acknowledgement
  3. References