Strategy for retreatment of therapeutic failure of eradication of Helicobacter pylori infection

Background and Aim: A proton pump inhibitor (PPI)‐based triple therapy consisting of a PPI, amoxicillin (A) and clarithromycin (C) or metronidazole (M) provides an eradication rate ranging from 80 to 90%. However, there have been few controlled studies with regard to the most effective regimen to re‐treat patients after failure of the first‐line therapy. Accordingly, we retrospectively reviewed our experiences and compared regimens with different combinations of antimicrobials to determine the optimal retreatment regimen. Methods: Out of 133 patients who had received second‐line therapy after failure of first‐line PPI/AC therapy, we selected, for review, patients who took the prescribed drugs for first‐line therapy equal to, or more than 80%. As a result, data on 114 patients (83 males and 31 females; mean age 49.1 ± 13.0 years; peptic ulcer n = 89; non‐ulcer dyspepsia, n = 25) were eligible for evaluation. They had either repeated the PPI/AC regimen (n = 34; 5–14 days), or had been administered the PPI/AM regimen (n = 80; 10 days). The cure rates of the two regimens were compared. Results: The eradication rates for second‐line therapy with the PPI/AC regimen versus the PPI/AM regimen were 52.9% (95% CI, 35–70) versus 81.3% (95% CI, 71–89) by intention‐to‐treat analysis (P < 0.01), and 62.1% (95% CI, 42–79) versus 91.4% (95% CI, 81–97) by per‐protocol analysis (P < 0.01). Conclusion: The eradication rate for the PPI/AM retreatment regimen was significantly higher than for the repeated PPI/AC regimen, suggesting that a 10‐day PPI/AM regimen can be recommended as a retreatment regimen for patients who had first‐line eradication therapy by PPI/AC regimens.