Comparison of Amoxicillin-Metronidazole Plus Famotidine or Lansoprazole for Amoxicillin-Clarithromycin-Proton Pump Inhibitor Treatment Failures for Helicobacter pylori Infection

• Published in: Helicobacter (Cambridge, Mass.) Mass.), 2006-10, Vol.11 (5), p.436-440
• Main Authors: Murakami, Kazunari, Okimoto, Tadayoshi, Kodama, Masaaki, Sato, Ryugo, Miyajima, Hajime, Ono, Masami, Inoue, Kunimitsu, Watanabe, Koichiro, Otsu, Satoshi, Fujioka, Toshio
• Format: Article
• Language: English
• Subjects: 2-Pyridinylmethylsulfinylbenzimidazoles - therapeutic use; Adult; Aged; Amoxicillin - therapeutic use; Anti-Bacterial Agents - therapeutic use; Anti-Ulcer Agents - therapeutic use; clarithromycin; Clarithromycin - therapeutic use; drug resistance; Drug Therapy, Combination; famotidine; Famotidine - therapeutic use; H. pylori; H2-receptor antagonist; Helicobacter Infections - drug therapy; Helicobacter pylori; Histamine H2 Antagonists - therapeutic use; Humans; Lansoprazole; metronidazole; Metronidazole - therapeutic use; Middle Aged; proton pump inhibitor; Proton Pump Inhibitors; Proton Pumps - metabolism; second-line eradication; Treatment Failure
• ISSN: 1083-4389; 1523-5378; 1478-4041
• DOI: 10.1111/j.1523-5378.2006.00435.x

Background:  Proton pump inhibitor–amoxicillin–metronidazole is recommended as second‐line Helicobacter pylori therapy in Japan. The authors assessed the efficacy and safety of second‐line eradication using the H2‐receptor antagonist famotidine as a substitute for proton pump inhibitor. Materials and methods:  Sixty‐one patients who failed in first‐line H. pylori eradication using proton pump inhibitor–clarithromycin–amoxicillin were randomly assigned to either second‐line therapy including metronidazole: a 7‐day course of lansoprazole 30 mg, amoxicillin 750 mg, and metronidazole 250 mg, b.i.d. (lansoprazole group); or a 7‐day course of famotidine 40 mg, amoxicillin 750 mg, and metronidazole 250 mg, b.i.d. (famotidine group). Eradication was assessed for each group at least 4 weeks after completing eradication therapy. Drug susceptibility test was performed using 57 strains in pretreatment to clarithromycin, metronidazole, and amoxicillin. Results:  Prior to second‐line H. pylori eradication, the rate of resistance to clarithromycin was high at 84% (48/57). Similarly, resistance to metronidazole was low at 5.3% (3/57); however, no amoxicillin‐resistant strains were found. The eradication rates for both lansoprazole and famotidine treatment groups were high at 97% (29/30) and 94% (29/31), respectively. Conclusions:  Famotidine treatment including metronidazole–amoxicillin as second‐line therapy provided a high eradication rate similar to lansoprazole therapy. Famotidine is therefore expected to serve as a useful H. pylori eradication regimen in patients with proton pump inhibitor allergy, an economic benefit in terms of reduced health‐care costs is also anticipated.