RESUMEN
BACKGROUND: Widespread use of eradication therapy for Helicobacter pylori has increased the prevalence of clarithromycin-resistant strains. The purpose of the present paper was to measure the in vitro antibacterial activity of minocycline against H. pylori, and study the effectiveness of minocycline-based first- and second-line eradication therapies. METHODS: For first-line therapy, 79 patients were randomly assigned to the treatment with rabeprazole, amoxicillin, and clarithromycin or with rabeprazole, amoxicillin, and minocycline. For second-line therapy, 88 patients were tested for sensitivity to metronidazole: 67 patients with metronidazole-sensitive strains received a 7-day course of rabeprazole, minocycline, and metronidazole; the remaining 21 patients were given a 7-day course of rabeprazole, minocycline, and faropenem. RESULTS: There was virtually no resistance to minocycline among the strains tested. The eradication rate of H. pylori infection in first-line therapy was significantly lower for minocycline-containing regimen (38.5%, 15/39) than for clarithromycin-containing regimen (82.5%, 33/40; P < 0.01). For second-line therapy, a high eradication rate against metronidazole-sensitive strains was obtained with rabeprazole, minocycline and metronidazole (85%, 57/67). CONCLUSIONS: A combination of rabeprazole, minocycline, and metronidazole is safe and effective for second-line therapy of H. pylori infection. Because this regimen can be administered to patients with penicillin allergy and patients who suffer adverse reactions to amoxicillin, such as diarrhea and other digestive symptoms, it should be considered useful for second- and third-line eradication therapy.
Asunto(s)
Antibacterianos/administración & dosificación , Infecciones por Helicobacter/tratamiento farmacológico , Helicobacter pylori , Minociclina/administración & dosificación , 2-Piridinilmetilsulfinilbencimidazoles , Amoxicilina/administración & dosificación , Antiulcerosos/administración & dosificación , Bencimidazoles/administración & dosificación , Claritromicina/administración & dosificación , Quimioterapia Combinada , Femenino , Gastritis/tratamiento farmacológico , Gastritis/microbiología , Infecciones por Helicobacter/microbiología , Helicobacter pylori/efectos de los fármacos , Humanos , Masculino , Metronidazol/administración & dosificación , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Minociclina/farmacología , Omeprazol/administración & dosificación , Omeprazol/análogos & derivados , Úlcera Péptica/tratamiento farmacológico , Úlcera Péptica/microbiología , Rabeprazol , Resultado del TratamientoRESUMEN
A complete response was obtained by interferon (IFN) therapy for hepatitis C virus (HCV)-related advanced chronic hepatitis after curative treatment of initial and recurrent hepatocellular carcinoma (HCC). The patient is alive 73 months after diagnosis of initial HCC and is in a tumor-free state 53 months after diagnosis of the last HCC. This case suggest that it is possible to suppress recurrence and to prolong the life of patients with HCV-related advanced chronic hepatitis, if a complete response is obtained by means of IFN therapy after the curative treatment of the recurrent HCC.