Efficacy and Safety of Rabeprazole, Amoxicillin, and Gatifloxacin After Treatment Failure of Initial Helicobacter pylori Eradication

• Published in: Helicobacter (Cambridge, Mass.) Mass.), 2006-08, Vol.11 (4), p.231-236
• Main Authors: Sharara, Ala I., Chaar, Hani F., Aoun, Elie, Abdul-Baki, Heitham, Araj, George F., Kanj, Souha S.
• Format: Article
• Language: English
• Subjects: 2-Pyridinylmethylsulfinylbenzimidazoles; Adult; Amoxicillin - administration & dosage; Amoxicillin - adverse effects; Amoxicillin - pharmacology; Amoxicillin - therapeutic use; Anti-Bacterial Agents - administration & dosage; Anti-Bacterial Agents - adverse effects; Anti-Bacterial Agents - pharmacology; Anti-Bacterial Agents - therapeutic use; Bacterial Proteins - analysis; Benzimidazoles - administration & dosage; Benzimidazoles - adverse effects; Benzimidazoles - pharmacology; Benzimidazoles - therapeutic use; Breath Tests; clarithromycin; Drug Therapy, Combination; Female; fluoroquinolones; Fluoroquinolones - administration & dosage; Fluoroquinolones - adverse effects; Fluoroquinolones - pharmacology; Fluoroquinolones - therapeutic use; Gastritis; Helicobacter Infections - drug therapy; Helicobacter Infections - microbiology; Helicobacter pylori; Helicobacter pylori - drug effects; Helicobacter pylori - isolation & purification; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Omeprazole - administration & dosage; Omeprazole - adverse effects; Omeprazole - analogs & derivatives; Omeprazole - pharmacology; Omeprazole - therapeutic use; peptic ulcer; Rabeprazole; rescue; resistance; Smoking; susceptibility; Treatment Outcome; Urease - analysis
• ISSN: 1083-4389; 1523-5378
• DOI: 10.1111/j.1523-5378.2006.00416.x

Objectives:  To evaluate the efficacy of a 7‐day regimen of gatifloxacin (400 mg daily), amoxicillin (1 g twice a day), and rabeprazole (20 mg twice a day) in the secondary eradication of Helicobacter pylori infection. Methods:  Eligible patients with persistent infection following one or more conventional clarithromycin‐containing triple therapies were enrolled in this open‐label trial. Eradication of infection was documented by 14C‐urea breath test a minimum of 4 weeks after therapy and 2 weeks off any acid suppressive therapy. Culture of H. pylori and in vitro susceptibility testing to amoxicillin, clarithromycin, and gatifloxacin was done in cases of failed eradication. Results:  A total of 45 patients (22 females:23 males; mean age 44.5 ± 13 years) were enrolled. Eradication occurred in 38 patients [both per‐protocol (PP) and intention‐to‐treat analysis: 84.4%; 95% CI: 74–95%]. No significant adverse effects were reported. In vitro susceptibility testing showed no secondary resistance to gatifloxacin or amoxicillin in any of the seven nonresponders. Smoking, age, and sex were not predictors of potential eradication failure. Conclusions:  A 7‐day regimen of gatifloxacin, rabeprazole, and amoxicillin is effective after failed eradication therapy for H. pylori and does not appear to result in secondary resistance. This combination is simple, well tolerated, and may lead to higher compliance and lower costs.