Efficacy of a therapeutic strategy for eradication of Helicobacter pylori infection

Table 1 Antibiotic regimens suggested by our unit and eradication rates per protocol

	Patients	H. pylori eradicated and eradication rate per protocol(95% CI)	Patientstreated and cumulative effect (95% CI)
First-line:	2428	1814
PPI b.i.d. + amoxicillin 1 g b.i.d. + clarithromycin 500 mg b.i.d. for 7 d		74.7 (72.7-76.4)
	Second-line:	326	278	2140
PPI b.i.d. + amoxicillin 1 g b.i.d. + tinidazole 500 mg b.i.d. for 14 d		85.3 (81.1-89.1)	97.8 (97.1-98.4)
Third-line:	19	17	2111
PPI b.i.d. + amoxicillin 1 g b.i.d. + levofloxacin 250 mg b.i.d. for 14 d		89.5 (74.9-103)	99.9 (99.8-100)

PPI: Proton pump inhibitor; b.i.d.: Twice daily; H. pylori: Helicobacter pylori. Standard dosages for PPIs are as follows: lansoprazole 30 mg, omeprazole 20 mg, pantoprazole 40 mg, rabeprazole 20 mg, esomeprazole 20 mg.

Table 2 Characteristics of patients who underwent urea breath test after treatment (%)

Patients characteristics	UBT after first-line therapy (2428 patients)	UBT after second-line therapy (326 patients)	UBT after third-line therapy (19 patients)
Women	1403 (58)	202 (62)	13 (68)
Men	1025 (42)	124 (38)	6 (32)
Mean age (range), yr	55 (18-92)	54 (21-86)	53 (27-80)
Peptic ulcer disease	202 (8.2)1	23 (7.1)	0
Previous gastric surgery and/or neoplasm	6 (0.2)2	3 (0.9)	0
Smokers	424/1082 (43.8)	59/287 (20.6)	3/17 (7.6)

¹172 and 23 patients were found to be affected respectively by duodenal and gastric ulcer. 7 patients were affected by both gastric and duodenal ulcer;

²1 patient was affected by low-grade mucosa-associated lymphoid tissue. Among the patients with a history of previous gastric surgery, 1 patient had undergone surgery for cancer, the others for peptic ulcer disease. UBT: Urea breath test.

Table 3 Factors investigated as potentially predictive of successful eradication (%)

Risk factor	Eradication rate
	First-line antibiotic regimen	Second-line antibiotic regimen
Women	1029/1403 (73.3)	172/202 (85.1)
Men	785/1025 (76.6)	106/124 (85.5)
Peptic ulcer disease	167/206 (81.1)1	22/24 (91.7)
Non-ulcer disease	1647/2222 (74.1)1	54/71 (76.1)
Smokers	302/424 (71.2)	50/57 (94.7)
Non-smokers	1346/1 778 (75.7)	192/230 (83.5)

¹Difference of frequencies: 6.9% (95% CI: 1%-12.8%, P < 0.05). If patients affected by duodenal ulcers is compared with patients with non-ulcer disease, the difference is 8.3% (95% CI: 2.3%-14.4%, P < 0.05).

Table 4 Characteristics of patients who rechecked or not their Helicobacter pylori status (%)

Patients characteristics	Rechecked their H. pylori status1 (297 patients)	No recheck of their H. pylori status (278 patients)
Women/men	185 (62)/112 (38)	170 (61)/108 (39)
Mean age (range), yr	55 (21-86)	50 (20-92)
Peptic ulcer disease	21 (7)	17 (6)
Previous gastric surgery and/or neoplasm	2 (0.6)	1 (0.3)
Smokers	53 (20)	69 (27)

¹Patient who rechecked their Helicobacter pylori (H. pylori) status, until the achievement of an urea breath test-proved H. pylori-status, or after the completion of the third-line therapy, whichever came first. Patients treated with alternative second and third-line antibiotic regimens are excluded.

Table 5 Studies reporting eradication rates and cumulative effect of different therapeutic strategies

% Eradication rate (number of patients)
	First-line	Second-line	Third-line	Cumulative effect (II to III line)	Antimicrobial susceptibility testing before third-line
Gasbarrini et al[41] 2000	86 (2413)	82 (329)	77 (39)	99	Yes
Beales[42] 2001	73 (469)	70-73 (66)	65 (20)	94-98	Yes
Qasim et al[40] 2005	77 (3280)	56 (270)	38 (28)
Gisbert et al[32] 2008	70 (500)	74 (343)	76 (136)	99.5	No
Rokkas et al[28] 2009	76 (540)	73 (120)	70 (30)	98	No
Present study	75 (2428)12	85 (326)	89 (19)	97.8-99.9	No

¹172 and 23 patients were found to be affected respectively by duodenal and gastric ulcer. 7 patients were affected by both gastric and duodenal ulcer;

²1 patient was affected by low-grade mucosa-associated lymphoid tissue. Among the patients with a history of previous gastric surgery, 1 patient had undergone surgery for cancer, the others for peptic ulcer disease. UBT: Urea breath test.