|
Clinical Question:
In patient with Helicobacter Pylori, what is the best treatment option if
patient is allergic to Penicillin?
Bottom Line:
H. pylori-infected patients who are allergic to penicillin may be treated
with a first-line treatment combining a proton-pump inhibitor,
clarithromycin and metronidazole. Rescue options may include a regimen with
ranitidine bismuth citrate, tetracycline and metronidazole. A levofloxacin-based
rescue regimen (with proton-pump inhibitor and clarithromycin) may also
represent an alternative, even when two or more consecutive eradication
treatments have previously failed. However, rifabutin + clarithromycin +
proton-pump inhibitor regimen is ineffective and poorly tolerated.
Reference:
Helicobacter pylori first-line treatment and rescue options in patients
allergic to penicillin.Gisbert JP, Gisbert JL, Marcos S, Olivares D, Pajares
JM.Aliment Pharmacol Ther. 2005 Nov 15;22(10):1041-6.
Study Design:
Prospective single centre study
Synopsis:
Helicobacter pylori eradication is a challenge in patients allergic to
penicillin, especially those who have failed a first-eradication trial. Aim
: To assess the efficacy and tolerability of H. pylori first-line treatment
and rescue options in patients allergic to penicillin. Prospective single
centre study including 40 consecutive treatments administered to patients
allergic to penicillin. Therapy regimens: First-line (12 patients)
omeprazole, clarithromycin and metronidazole for 7 days; second-line (17
patients) ranitidine bismuth citrate, tetracycline and metronidazole for 7
days; third-line (nine patients) rifabutin, clarithromycin and omeprazole
for 10 days; and fourth-line (two patients) levofloxacin, clarithromycin and
omeprazole for 10 days. Outcome variable: a negative (13)C-urea breath test
8 weeks after completion of treatment.Per-protocol/intention-to-treat
eradication rates were: first-line (64/58%); second-line (ranitidine bismuth
citrate; 53/47%); third-line (rifabutin; 17/11%) and fourth-line regimen (levofloxacin;
100/100%). Compliance with treatment was generally good, except with the
rifabutin-based regimen, which presented adverse effects in 89% of the
patients, including four cases of myelotoxicity. |