[Failure of Helicobacter pylori eradication--suggestions for further therapy]

Success of first H. pylori eradication attempts in the literature is around 80-90% and based on urea breath test of 1027 patients in Hungary is 75%. Repeated eradication attempts are needed in 10-25% of cases. In the clinical practice in Hungary second and third eradication attempts were successful only in 36% and 20% of cases. To improve efficacy the following suggestions has to be kept in mind: 1. Do not repeat the same combination if the first attempt is failed. 2. After failure of the first PPI + amoxicillin + clarithromycin triple therapy, either the quadriple therapy (PPI + tetracycline + metronidazole + bismuth) or the replacement of PPI with ranitidine bismuth citrate in the triple therapy is suggested. 3. If PPI + amoxicillin + metronidazole/tinidazole therapy fails, the metronidazole/tinidazole can be replaced by clarythromycin. 4. Do not start with clarithromycin + metronidazole/tinidazole therapy. 5. In case of uncertain previous therapies and for third eradication treatment send the patient to specialist. Rifabutin-based combinations seem to be effective, but the use of them in general practice is not advised due to the possible development of mycobacterium tuberculosis resistance.