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

Abstract

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.

Keywords

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

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Copyright information

© Springer Science + Business Media, Inc. 2005

Authors and Affiliations

  • Maribel RodrÍguez-Torres
    • 1
    • 3
    • 5
  • 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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