5 research outputs found
Second-Line Rescue Therapy of Helicobacter Pylori Infection
Helicobacter pylori infection is the main known cause of gastritis,
gastroduodenal ulcer disease and gastric cancer. After more than 20 years of
experience in H. pylori treatment, however, the ideal regimen
to treat this infection has still to be found. Nowadays, apart from having to
know well first-line eradication regimens, we must also be prepared to face
treatment failures. Therefore, in designing a treatment strategy we should not
focus on the results of primary therapy alone, but also on the final (overall)
eradication rate. The choice of a ‘rescue’ treatment
depends on which treatment is used initially. If a first-line
clarithromycin-based regimen was used, a second-line metronidazole-based
treatment (quadruple therapy) may be used afterwards, and then a
levofloxacin-based combination would be a third-line
‘rescue’ option. Alternatively, it has recently been
suggested that levofloxacin-based ‘rescue’ therapy
constitutes an encouraging second-line strategy, representing an alternative to
quadruple therapy in patients with previous PPI-clarithromycin-amoxicillin
failure, with the advantage of efficacy, simplicity and safety. In this case,
quadruple regimen may be reserved as a third-line ‘rescue’
option. Finally, rifabutin-based ‘rescue’ therapy
constitutes an encouraging empirical fourth-line strategy after multiple
previous eradication failures with key antibiotics such as amoxicillin,
clarithromycin, metronidazole, tetracycline, and levofloxacin. Even after two
consecutive failures, several studies have demonstrated that H.
pylori eradication can finally be achieved in almost all patients if
several ‘rescue’ therapies are consecutively given.
Therefore, the attitude in H. pylori eradication therapy
failure, even after two or more unsuccessful attempts, should be to fight and
not to surrender