Helicobacter pylori eradication in Western Australia using novel quadruple therapy combinations

Background Helicobacter pylori eradication rates with standard triple therapy are decliningworldwide. The optimal management of H. pylori is evolving and newtreatment combinations for antibiotic resistant H. pylori strains arerequired, especially for patients with penicillin allergy.AimTo review the effectiveness of alternative antibiotic combinations and necessityof pre-antibiotic sensitivity testing.MethodsA total of 310 consecutive patients who had failed at least one course of standard7-day triple therapy initially prescribed by their physicians were includedin this study between year 2007 and 2011. Antibiotics were prescribed basedon pre-antibiotic sensitivity tests and, if any, patient’s allergy to penicillin.ResultsIn 98.7% of the patients’ samples, H. pylori was successfully cultured. Theproportion resistant to clarithromycin and metronidazole was 94.1% and67.6% respectively, with 65% resistant to both. For the in-house primary quadrupletherapy, with Proton pump inhibitor, Amoxicillin, Rifabutin and Ciprofloxacin(PARC), H. pylori was successfully eradicated in 95.2% of patients.For patients allergic to amoxicillin, an alternative quadruple therapy usingProton pump inhibitor, Bismuth subcitrate, Rifabutin and Ciprofloxacin(PBRC) gave an eradication rate of 94.2%. Patients needing alternative salvagetherapy were given novel personalised combinations consisting of bismuth,rifabutin, tetracycline or furazolidone; the eradication rate was 73.8%.ConclusionsPatients who present with antibiotic resistant H. pylori can be confidentlytreated with PARC, PBRC or other personalised salvage therapies. Theseregimens can be used when treatment options are limited by penicillinallergy. Pre-treatment H. pylori antibiotic sensitivity tests contributed to thehigh eradication rate in this study.