A Triple Therapy with Doxycycline Is Ineffective for Multidrug-Resistant H. pylori

David J. Bjorkman, MD, MSPH (HSA), SM (Epid.)

In a proof-of-concept study in Portugal, none of the 15 patients completing a 10-week course of pantoprazole, amoxicillin, and doxycycline was cured.

Standard therapies for Helicobacter pylori infection have decreasing effectiveness because of increasing drug resistance. Tetracycline is a common component of different H. pylori treatment regimens, but doxycycline may have potential therapeutic advantages of better tissue penetration and less frequent dosing. In an effort to identify a potential therapy for patients with multidrug-resistant H. pylori infection, investigators in Portugal prospectively studied the efficacy of a proton-pump inhibitor (PPI), amoxicillin, and doxycycline regimen.

The study comprised 16 patients (13 women, 3 men) with known resistance to clarithromycin, metronidazole, and levofloxacin but susceptibility to amoxicillin and tetracycline based on cultures of endoscopic biopsies. Patients received pantoprazole (80 mg) twice daily for 3 days followed by a 10-day course of pantoprazole (80 mg), amoxicillin (1 g), and doxycycline (100 mg), all twice daily. Fifteen patients completed the therapy. Eradication success was determined by a breath test at 6 to 10 weeks after treatment.

All patients showed persistent H. pylori infection after therapy. The authors conclude that triple therapy with a proton-pump inhibitor, amoxicillin, and doxycycline is useless in patients with multidrug-resistant H. pylori infection.

Citation(s):

Almeida N et al. Triple therapy with high-dose proton-pump inhibitor, amoxicillin, and doxycycline is useless for Helicobacter pylori eradication: A proof-of-concept study. Helicobacter 2014 Apr; 19:90.