Consecutive Quadruple Therapies for Difficult-to-Treat Helicobacter pylori Infection

Helicobacter pylori, bacterium which causes gastric and duodenal ulcer
Investigators assessed the safety and efficacy of two 1-week quadruple therapies given consecutively in patients with difficult-to-treat Helicobacter pylori infections.

Consecutive quadruple therapy with amoxicillin, tetracycline, and furazolidone achieved a satisfactory cure rate in difficult-to-treat Helicobacter pylori (H pylori) infections, according to a study published in Clinical and Translational Gastroenterology.

H pylori eradication has become a therapeutic challenge due to increasing antibiotic resistance. Researchers in China conducted a pilot study to evaluate the efficacy and tolerability of 2 different 1-week quadruple therapies given back to back, consecutively in 65 patients with proven H pylori infection. Patients included in the cohort had more than 3 failed standard quadruple eradications.

Patients received esomeprazole 40 mg or rabeprazole 20 mg twice daily, amoxicillin 1000 mg twice daily, tetracycline 500 mg 4 times daily, and furazolidone 100 mg 3 times daily for the first 7 days, followed by colloidal bismuth pectin 200 mg twice daily in place of furazolidone 100 mg for another 7 days. Eradication rates, treatment-emergent adverse events (TEAEs), and compliance were assessed.

The researchers found that the intention-to-treat and per-protocol eradication rates were 90.8% (59/65) and 95.1% (58/61), respectively. In total, 23.4% (15/64) of patients experienced TEAEs and there were no serious adverse events. In addition, no treatment was required for TEAEs, and 95.3% (61/64) of patients demonstrated good compliance.

Overall, H pylori were successfully isolated in 78.5% (51/65) of patients and resistance rates of H pylori isolates to clarithromycin, metronidazole, levofloxacin, and amoxicillin were 60.8% (31/51), 100% (51/51), 70.6% (36/51), and 2.0% (1/51), respectively. No resistance was detected to either furazolidone or tetracycline; however, H pylori was resistant to metronidazole, levofloxacin, and clarithromycin in 54.9% of patients.

Investigators acknowledge this study was limited by its single-arm design. Additionally, the antibiotic compounds included in the quadruple therapy are not always readily available in some areas.

The authors concluded, “This pilot study showed that even after previous H. pylori eradication failures in a specific population with high levels of multiple antimicrobial resistance, consecutive therapy including amoxicillin, tetracycline, and furazolidone, was feasible to achieve a good eradication rate (>90%) with acceptable tolerability and good compliance, regardless of a medication history of these 3 antibiotics.”


Liu J, Ji C-R, Li Y-Y, et al. Two different 1-week quadruple therapies given back-to-back consecutive therapy for difficult-to-treat Helicobacter pylori infection: A pilot study. Clin Transl Gastroenterol. 2021; 12(8):e00391. doi: 10.14309/ctg.0000000000000391

This article originally appeared on Gastroenterology Advisor