Multiple-antibiotic-resistant Helicobacter pylori infection eradicated with a tailor-made quadruple therapy.

In 2008, a 44-year-old woman with mild epigastralgia diagnosed as having Helicobacter pylori-positive chronic gastritis without peptic ulcer underwent eradication therapy with lansoprazole (LPZ), amoxicillin (AMPC) and clarithromycin (CAM) for 7 days, but it failed, so treatment with rabeprazole, AMPC, and metronidazole (MNZ) for another 7 days was given, but it also failed. She was then prescribed a modified, 14-day sequential therapy of LPZ and AMPC with an increased dose of CAM followed by MNZ supplement, but the infection was still not eradicated. The H. pylori was cultured and examined for antibiotic susceptibility with the agar dilution method and was found to be resistant to CAM, MNZ, and levofloxacin, and non-sensitive to AMPC, namely multiple-antibiotic-resistant, although sensitive to minocycline. The CYP2C19 genotype of the patient was an extensive metabolizer (G681A: G/A, G636A: G/G). In 2010, she gave informed consent for a 14-day, tailor-made, modified classical (or modified high-dose PPI + AMPC) quadruple therapy comprising 30 mg LPZ, 500 mg AMPC and 500 mg bismuth subnitrate, qid, and 100 mg minocycline, bid. Two months later, her urea breath test was negative. Histology and bacterial culture were still negative 1 year after the therapy. She did not have any adverse events during or after the novel therapy, nor did she feel any further epigastralgia.

Effect of the folk remedy, Bainiku-ekisu, a concentrate of Prunus mume juice, on Helicobacter pylori infection in humans.

BACKGROUND: Bainiku-ekisu, a concentrate of Japanese apricot (Prunus mume) juice, is a traditional Japanese folk remedy for treatment of dyspepsia since more than a thousand years ago. Fujita et al. previously reported in vitro antibacterial effect of Bainiku-ekisu to Helicobacter pylori. We conducted an in vivo pilot study to evaluate the possibility that Bainiku-ekisu may have an antibacterial effect on H. pylori in the human stomach. MATERIALS AND METHODS: Consecutive 18 H. pylori-positive subjects were included. Approximately 130 mL 1% Bainiku-ekisu solution was ingested by the subjects twice a day for 12 weeks. Urea breath test (UBT) was performed before ingestion, and 2 and 12 weeks after starting ingestion of Bainiku-ekisu, and UBT values were compared. RESULTS: Bainiku-ekisu therapy resulted in a slight fall in UBT values after 2 weeks (from 30.1 +/- 6 to 23.5 +/- 6 in ITT analysis, p = .094; from 31.2 +/- 6 to 24.7 +/- 6 in PP analysis, p = .124) (data are shown with mean +/- SE). In two instances (11%), the UBT values became negative. Fourteen subjects completed the trial for 12 weeks and there was no significant change in UBT values (from 30.1 +/- 6 to 25.9 +/- 6 in ITT analysis, p = .450; from 35.6 +/- 6 to 31.4 +/- 7 in PP analysis, p = .555). CONCLUSION: Our results are consistent with the antibacterial effect of Bainiku-ekisu on H. pylori in the human stomach. However, the bacteria were not successfully eradicated with 2- or 12-week ingestion of a Bainiku-ekisu solution. Subsequent studies will need to identify a clinically useful regimen.