Supplement Abstracts Submitted for the 70th Annual Scientific Meeting of the American College of Gastroenterology: ESOPHAGUS
Purpose: The success rate of anti-H. pylori therapy has continued to fall in part due to increasing resistance.
Aim: To test the sequential combination of high dose PPI-amoxicillin followed by the addition of gatifloxacin for H. pylori infection.
Methods: This was a pilot study where patients with active H. pylori infection received sequential therapy consisting of 40 mg of esomeprazole and 1 g amoxicillin t.i.d, for 12 days. Both naive and treatment failures were eligible. On days 6 through 12 gatifloxacin (400 mg in the a.m.) was added to produce a triple therapy. Outcome was accessed by UBT or endoscopy with histology and culture done 4–6 weeks after ending antibiotic therapy.
Results: To date, the cure rate has been 100% among those who received all three drugs. One patient stopped therapy after receiving only the PPI plus amoxicillin and therapy was unsuccessful Side effects consist of mild diarrhea/loose stools in 25%. Another patient in whom gatifloxacin was contraindicated received 40 mg of esomeprazole and 1 g amoxicillin t.i.d, for 12 days and then metronidazole 500 mg t.i.d on days 6 through 12 and the infection was treated successfully.
Conclusions: Sequential therapy using the combination of high dose PPI and amoxicillin (the German therapy) followed by the addition of gatifloxacin appears to be an excellent first or second line therapy for H. pylori infections.