USE OF A COMBINATION FORMULATION OF BISMUTH, LEVOFLOXACINE, AMOXICILLINE AND PROTON PUMP INHIBITOR AS A RESCUE THERAPY FOR THE ERADICATION OF HELICOBACTER PYLORI
Abstract:
Introduction: Helicobacter pylori are associated with both benign and malignant diseases of
the upper gastrointestinal tract while the increasing antibiotic resistance to the standard triple therapy
with PPI, Amoxicilline and Metronidazole has made alternative treatments necessary. The aim of this
study was to assess the efficacy and safety of a quadruple therapy consisting of Bismuth Subcitrate,
Levofloxacine, Amoxicilline and Esomeprazole. Methods: Between September 2015 and January 2016,
we have analysed 76 patients found to be HP + via the rapid urea breathing test at the Clinical
Emergency Hospital Sibiu. The patient mean age was 38 years, 54% were males and 46% females. 43
patients were treatment naive and 32 patients had previous failed a course of triple therapy within the
past year. Subjects were treated for 14 days with a combination of Bismuth Subcitrate 120mg QID,
Levofloxacine 250mg BID, Amoxicilline 1000mg BID and Esomeprazole 20mg BID. Upon completion,
subjects received another 14 days of Esomeprazole and Bismuth Subcitrate. Primary endpoint was HP
eradication rate, defined as one negative urea breathing test 28 days post-treatment. Results and
discussions: HP eradication rates ranged between 92% in patients who had failed a previous course of
triple therapy (n=32), and 94% in treatment naive patients (n=43). Twelve subjects (15,78%) reported
mild adverse events, one subject had to discontinue the study due to these. Conclusions: A quadruple
regimen of Bismuth Subcitrate, Levofloxacine, Amoxicilline and Esomeprazole produces a high
eradication rate in both subjects who have previously failed the triple HP eradication regimen as well as
in treatment naive patients. Hence, the quadruple regimen described here in offers an efficacious option
both as rescue as well as initial treatment.
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