Rabeprazole-Based Rescue Therapy for Helicobacter pylori Successful in Malaysia

After PPI-based triple therapy failed, most infections were eradicated with rabeprazole and amoxicillin.


Eradication rates for Helicobacter pylori infection using a triple therapy with a proton-pump inhibitor (PPI) and clarithromycin vary considerably in different countries. In some countries, bacterial resistance to this treatment appears to be increasing. When initial treatment fails, the optimal rescue therapy is often complex and unclear.

Investigators in Malaysia conducted a sequential study using rabeprazole-based therapies in patients who had failed a 1-week triple therapy with a PPI and clarithromycin. After confirmation of persistent infection with a breath test, 149 consecutive patients were treated with 20 mg of rabeprazole and 1 g of amoxicillin three times daily for 2 weeks. If a second breath test showed persistent infection, patients were then treated with 20 mg of rabeprazole, 500 mg of levofloxacin and 1 g of amoxicillin twice daily for 2 weeks.

Based on intent-to-treat analysis, the first treatment was successful in 107 of 149 patients (71.8%; 95% confidence interval, 64.6–79.0%), and the second treatment was successful in 28 of 31 patients (90.3%; 95% CI, 74.2–98.0%). Both therapies were tolerated well, with only a few mild adverse effects.


Citation(s):

Goh K-L et al. High-dose rabeprazole–amoxicillin dual therapy and rabeprazole triple therapy with amoxicillin and levofloxacin for 2 weeks as first and second line rescue therapies for Helicobacter pylori treatment failures. Aliment Pharmacol Ther 2012 May; 35:1097.