Digestive Diseases and Sciences

, Volume 50, Issue 4, pp 634–639 | Cite as

High Eradication Rates of Helicobacter pylori Infection with First- and Second-Line Combination of Esomeprazole, Tetracycline, and Metronidazole in Patients Allergic to Penicillin

  • Maribel RodrÍguez-TorresEmail author
  • Rosa Salgado-Mercado
  • Carlos F. RÍos-Bedoya
  • Edgardo Aponte-Rivera
  • Acisclo M. Marxuach-Cuétara
  • José F. RodrÍguez-Orengo
  • Alberto Fernández-Carbia


H. pylori eradication is a challenge in patients allergic to penicillin, both first-line and failures of prior therapy. We aimed to assess the eradication rate of H. pylori in patients allergic to penicillin, first-line and failures of prior therapy, the efficacy of healing of active duodenal ulcer disease (DUD) and erosive gastritis, and the safety and tolerability of the combination. Twenty patients with documented allergy to penicillin, DUD, and H. pylori infection, 17 (85%) for first-line treatment and 3 (15%) prior therapy failures, were given a 10-day regimen of esomeprazole, 40 mg qid, tetracycline, 500 mg qid, and metronidazole, 500 mg qid. Baseline and follow-up panendoscopy ≥ 30 days after end of treatment was performed for rapid urease test (Clotest), and four site biopsies for H. pylori, and to document endoscopic peptic ulcer disease. All adverse events during treatment were documented. Eradication rates by intention to treat (ITT) were 85% for first-line treatment and 100% for failures. Seventy percent of all cases had a normal endoscopy at follow-up, and 85 and 100% of patients had healed erosive gastritis and DUD, respectively, from baseline. There were histological improvements in most patients. A high eradication rate was obtained even in patients who had a shorter duration of treatment. The combination was well tolerated. A combination of esomeprazole, tetracycline, and metronidazole is effective for eradication of H. pylori in patients allergic to penicillin, for both first-line treatment and failures of prior treatment.


Helicobacter pylori penicillin-free esomeprazole first-line therapy second-line therapy 


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  1. 1.
    Go MF: Natural history and epidemiology of Helicobacter pylori infection. Aliment Pharmacol Ther 16(Suppl 1):3–15, 2002PubMedGoogle Scholar
  2. 2.
    Blaser MJ: Hypothesis: the changing relationships of Helicobacter pylori and humans: implications for health and disease. J Infect Dis 179:1523–1530, 1999PubMedGoogle Scholar
  3. 3.
    Rauws EAJ, Tytgat GNY: Cure of duodenal ulcer disease associated with eradication of Helicobacter Pylori. Lancet 2:1233–1235, 1990Google Scholar
  4. 4.
    Megraud F, Brassens-Rabbe MP, Denis F: Seroepidemiology of Campylobacter pylori infection in various populations. J Clin Microbiol 27:1870–1873, 1989PubMedGoogle Scholar
  5. 5.
    Zarrilli R, Ricci V, Romano M: Molecular response of gastric epithelial cells to Helicobacter pylori-induced cell damage. Cell Microbiol 1:93–99, 1999PubMedGoogle Scholar
  6. 6.
    Peek RM Jr, Blaser MJ: Helicobacter pylori and gastrointestinal tract adenocarcinomas. Nature Rev Cancer 2:28–37, 2002CrossRefGoogle Scholar
  7. 7.
    NIH Consensus Conference: Helicobacter pylori in peptic ulcer disease. JAMA 272:65–69, 1994Google Scholar
  8. 8.
    Malfertheiner P, Megraud F, O Morain C: Current concepts in the management of Helicobacter pylori infection. The Maastricht 2-2000 Concensus Report. Aliment Pharmacol Ther 16:167–180, 2000Google Scholar
  9. 9.
    Gisbert JP, Pajares JM, Racz I: The year in Helicobacter pylori therapy 2001. Curr Opin Gastroenterol 17(Suppl 1):S47–S54, 2001Google Scholar
  10. 10.
    Megraud F: Epidemiology and mechanism of antibiotic resistance in Helicobacter pylori. Gastroenterology 115:1278–1272, 1998PubMedGoogle Scholar
  11. 11.
    Graham DY: Antibiotic resistance in Helicobacter pylori: implications for therapy. Gastroenterology 115:1272–1277, 1998PubMedGoogle Scholar
  12. 12.
    Huang J, Hunt RH: The importance of clarithromycin dose in the management of Helicobacter pylori infection: a meta-analysis of triple therapies with a proton pump inhibitor, clarithromycicn and amoxicillin or metronidazole. Aliment Pharmacol Ther 13:719–729, 1999CrossRefPubMedGoogle Scholar
  13. 13.
    Gerrits MM, Schuijffel D, van Zwet AA, Kuipers EJ, Vandenbroucke-Grauls CM, Kusters JG: Alterations in penicillin-binding protein 1A confer resistance to beta-lactam antibiotics in Helicobacter pylori. Antimicrob Agents Chemother 46:2229–2233, 2002PubMedGoogle Scholar
  14. 14.
    Kwon DH, Kim JJ, Lee M, et al.: Isolation and characterization of tetracycline-resistant clinical isolates of Helicobacter pylori. Antimicrob Agents Chemother 44:3203–3205, 2000PubMedGoogle Scholar
  15. 15.
    Iovene MR, Romano M, Pilloni AO, et al.: Prevalence of antimicrobial resistance in eighty clinical isolates of Helicobacter pylori. Chemotherapy. 45:8–14, 1999PubMedGoogle Scholar
  16. 16.
    Debets-Ossenkopp YJ, Herscheid AJ, Pot RG, Kuipers EJ, Kusters JG, Vanderbroucke-Grauls CM: Prevalence of Helicobacter pylori resistance to metronidazole, clarithromycin, amoxicillin, tetracycline and trovafloxacin in the Netherlands. J Antimicrob Chemother 43:511–415, 1999PubMedGoogle Scholar
  17. 17.
    Laine L, Fennerty MB, Suchower L, et al.: H. pylori antibiotic resistance, eradication and emergent resistance in U.S. double-blind trials of esomeprazole, clarithromycin, and amoxicillin. Gastroenterology 118(Suppl 2):A498, 2000CrossRefGoogle Scholar
  18. 18.
    Vergara M, Vallve M, Gisbert JP, Calvet X: Meta-analysis: comparative efficacy of different proton-pump inhibitors in triple therapy for Helicobacter pylori eradication. Aliment Pharmacol Ther 18(6):647–654, 2003CrossRefPubMedGoogle Scholar
  19. 19.
    Laine L: Review article: esomeprazole in the treatment of Helicobacter pylori. Aliment Pharmacol Ther 16(Suppl 4):115–118, 2002PubMedGoogle Scholar
  20. 20.
    Tulassay Z, Kryszewski A, Dite P, Kleczkowski D, Rudzinski J, Bartuzi Z, Hasselgren G, Larko A, Wrangstadh M: One week of treatment with esomeprazole-based triple therapy eradicates Helicobacter pylori and heals patients with duodenal ulcer disease. Eur J Gastroenterol Hepatol 13(12):1457–1465, 2001PubMedGoogle Scholar
  21. 21.
    Veldhuyzen Van Zanten S, Lauritsen K, Delchier JC, Labenz J, De Argila CM, Lind T, Treichel HC, Stubberod A, Cockeram A, Hasselgren G, Gothe L, Wrangstadh M, Sinclair P: One-week triple therapy with esomeprazole provides effective eradication of Helicobacter pylori in duodenal ulcer disease. Aliment Pharmacol Ther 14(12):1605–1611, 2000PubMedGoogle Scholar
  22. 22.
    Veldhuyzen Van Zanten S, Machado S, Lee J: One-week triple therapy with esomeprazole, clarithromycin and metronidazole provides effective eradication of Helicobacter pylori infection. Aliment Pharmacol Ther 17(11):1381–1387, 2003PubMedGoogle Scholar
  23. 23.
    Miehlke S, Schneider-Brachert W, Bastlein E, Ebert S, Kirsch C, Haferland C, Buchner M, Neumeyer M, Vieth M, Stolte M, Lehn N, Bayerdorffer E: Esomeprazole-based one-week triple therapy with clarithromycin and metronidazole is effective in eradicating Helicobacter pylori in the absence of antimicrobial resistance. Aliment Pharmacol Ther 18(8):799–804, 2003PubMedGoogle Scholar
  24. 24.
    Laine L, Fennerty MB, Osato M, Sugg J, Suchower L, Probst P, Levine JG: Esomeprazole-based Helicobacter pylori eradication therapy and the effect of antibiotic resistance: results of three US multicenter, double-blind trials. Am J Gastroenterol 95(12):3393–3398, 2000PubMedGoogle Scholar
  25. 25.
    Murakami K, Sato R, Okimoto T, Nasu M, Fujioka T, Kodama M, Kagawa J: Efficacy of triple therapy comprising rabeprazole, amoxicillin and metronidazole for second-line Helicobacter pylori eradication in Japan, and the influence of metronidazole resistance. Aliment Pharmacol Ther 17(1):119–123, 2003PubMedGoogle Scholar
  26. 26.
    Peitz U, Sulliga M, Wolle K, Leodolter A, Von Arnim U, Kahl S, Stolte M, Borsch G, Labenz J, Malfertheiner P: High rate of post-therapeutic resistance after failure of macrolide-nitroimidazole triple therapy to cure Helicobacter pylori infection: impact of two second-line therapies in a randomized study. Aliment Pharmacol Ther 16(2):315–324, 2002PubMedGoogle Scholar
  27. 27.
    Baena Diez JM, Lopez Mompo C, Rams Rams F, Garcia Lareo M, Rosario Hernandez Ibanez M, Teruel Gila J: Efficacy of a multistep strategy for Helicobacter pylori eradication: quadruple therapy with omeprazole, metronidazole, tetracycline and bismuth after failure of a combination of omeprazole, clarithromycin and amoxicillin. Med Clin 115(16):617–619, 2000Google Scholar

Copyright information

© Springer Science + Business Media, Inc. 2005

Authors and Affiliations

  • Maribel RodrÍguez-Torres
    • 1
    • 3
    • 5
    Email author
  • Rosa Salgado-Mercado
    • 1
  • Carlos F. RÍos-Bedoya
    • 3
  • Edgardo Aponte-Rivera
    • 1
  • Acisclo M. Marxuach-Cuétara
    • 1
  • José F. RodrÍguez-Orengo
    • 2
  • Alberto Fernández-Carbia
    • 4
  1. 1.Fundación de Investigación de DiegoSan Juan
  2. 2.Department of Biochemistry, School of MedicineUniversity of Puerto RicoSan Juan
  3. 3.Ponce School of MedicinePonce
  4. 4.University PathologistsSan JuanPuerto Rico
  5. 5.Fundación de Investigación de DiegoSanturcePuerto Rico

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