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BioMed Research International
Volume 2015, Article ID 163960, 6 pages
http://dx.doi.org/10.1155/2015/163960
Clinical Study

Comparison of Second-Line Quadruple Therapies with or without Bismuth for Helicobacter pylori Infection

1Graduate Institute of Clinical Medicine, Kaohsiung Medical University, Kaohsiung City 807, Taiwan
2Department of Internal Medicine, Kaohsiung Municipal United Hospital, Kaohsiung City 804, Taiwan
3Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan
4Department of Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung City 807, Taiwan
5Center for Stem Cell Research, Kaohsiung Medical University, Kaohsiung City 807, Taiwan
6Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung City 812, Taiwan
7School of Medicine, College of Medicine, E-Da Hospital, I-Shou University, Kaohsiung City 824, Taiwan
8Division of Gastroenterology, Department of Internal Medicine, Buddhist Tzu Chi General Hospital and School of Medicine, Tzu Chi University, Hualien 970, Taiwan
9Division of Gastroenterology, Department of Internal Medicine, Mackay Memorial Hospital, Taitung Branch, Taitung City 950, Taiwan
10Department of Internal Medicine, Kaohsiung Municipal Cijin Hospital, Kaohsiung City 812, Taiwan
11Center for Infectious Disease and Cancer Research, Kaohsiung Medical University, Kaohsiung City 807, Taiwan
12Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, National Yang-Ming University, Kaohsiung 813, Taiwan

Received 26 September 2014; Revised 16 February 2015; Accepted 16 February 2015

Academic Editor: Paul M. Tulkens

Copyright © 2015 Guang-Hong Jheng et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

The bismuth-based quadruple regimen has been applied in Helicobacter pylori rescue therapy worldwide. The non-bismuth-based quadruple therapy or “concomitant therapy” is an alternative option in first-line eradication but has not been used in second-line therapy. Discovering a valid regimen for rescue therapy in bismuth-unavailable countries is important. We conducted a randomized controlled trial to compare the efficacies of the standard quadruple therapy and a modified concomitant regimen. One hundred and twenty-four patients were randomly assigned into two groups: RBTM (rabeprozole 20 mg bid., bismuth subcitrate 120 mg qid, tetracycline 500 mg qid, and metronidazole 250 mg qid) and RATM (rabeprozole 20 mg bid., amoxicillin 1 g bid., tetracycline 500 mg qid, and metronidazole 250 mg qid) for 10 days. The eradication rate of the RBTM and RATM regimen was 92.1% and 90.2%, respectively, in intention-to-treat analysis. Patients in both groups had good compliance (~96%). The overall incidence of adverse events was higher in the RATM group (42.6% versus 22.2%, ), but only seven patients (11.5%) experienced grades 2-3 events. In conclusion, both regimens had good efficacy, compliance, and acceptable side effects. The 10-day RATM treatment could be an alternative rescue therapy in bismuth-unavailable countries.