Efficacy of a "rescue" ciprofloxacin-based regimen for eradication of helicobacter pylori infection after treatment failures

The aim of our study was to evaluate the efficacy and tolerability of a ciprofloxacin-based regimen for H. pylori eradication failures as an alternative to bismuth based quadruple therapy. Methods. Design: prospective single-center study. Patients in whom a first eradication trial with omeprazole/esomeprazole, clarithromycin plus amoxicillin or tinidazole/metronidazole had failed were included. H. pylori status: established by histology, rapide urease test and polymerase chain reaction. Intervention: esomeprazole 20mg, ciprofloxacin 500mg, and metronidazole 500mg, administered together before breakfast and dinner for 10 days. Susceptibility testing was performed by the Epsilometer test. Ciprofloxacin resistance was defined as a MIC of ≥1g/mL. Eradication was established by a negative 13C-UBT and 46 weeks post-therapy. Efficacy and side effects were determined. Results. 34 patients were enrolled, 32 completed the study. Compliance was excellent (100). Side effects were mild. Ciprofloxacin-based therapy cured 65 (22/34) of patients by intention to treat and 69 (22/32) per protocol analysis. The prevalence of ciprofloxacin resistance was 8. Conclusions. The effectiveness of ciprofloxacin-based therapy was greatly reduced despite the high prevalence of ciprofloxacin sensitive H. pylori strains. Bismuth based quadruple therapy still remain the best choice as a rescue regimen in our region. Copyright © 2012 Maria Pina Dore et al.