Dual therapy for third-line helicobacter pylori eradication and urea Breath test prediction

Toshihiro Nishizawa, Hidekazu Suzuki, Takama Maekawa, Naohiko Harada, Tatsuya Toyokawa, Toshio Kuwai, Masanori Ohara, Takahiro Suzuki, Masahiro Kawanishi, Kenji Noguchi, Toshiyuki Yoshio, Shinji Katsushima, Hideo Tsuruta, Eiji Masuda, Munehiro Tanaka, Shunsuke Katayama, Norio Kawamura, Yuko Nishizawa, Toshifumi Hibi, Masahiko Takahashi

Research output: Contribution to journalArticlepeer-review

19 Citations (Scopus)


We evaluated the efficacy and tolerability of a dual therapy with rabeprazole and amoxicillin (AMX) as an empiric third-line rescue therapy. In patients with failure of first-line treatment with a proton pump inhibitor (PPI)-AMX-clarithromycin regimen and second-line treatment with the PPI-AMX-metronidazole regimen, a third-line eradication regimen with rabeprazole (10 mg q.i.d.) and AMX (500 mg q.i.d.) was prescribed for 2 wk. Eradication was confirmed by the results of the 13C-urea breath test (UBT) at 12 wk after the therapy. A total of 46 patients were included; however, two were lost to follow-up. The eradication rates as determined by per-protocol and intention-to-treat analyses were 65.9% and 63.0%,respectively. The pretreatment UBT results in the subjects showing eradication failure; those patients showing successful eradication comprised 32.9 ± 28.8 permil and 14.8 ± 12.8 permil, respectively. The pretreatment UBT results in the subjects with eradication failure were significantly higher than those in the patients with successful eradication (P= 0.019). A low pretreatment UBT result (≤ 28.5 permil) predicted the success of the eradication therapy with a positive predictive value of 81.3% and a sensitivity of 89.7%. Adverse effects were reported in 18.2% of the patients, mainly diarrhea and stomatitis. Dual therapy with rabeprazole and AMX appears to serve as a potential empirical third-line strategy for patients with low values on pretreatment UBT.

Original languageEnglish
Pages (from-to)2735-2738
Number of pages4
JournalWorld Journal of Gastroenterology
Issue number21
Publication statusPublished - 2012
Externally publishedYes


  • Amoxicillin
  • Dual therapy
  • Eradication
  • Helicobacter pylori
  • Urea breath test

ASJC Scopus subject areas

  • Gastroenterology


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