The Efficacy of Sequential Therapy as Second Line Therapy for Refractory Helicobacter Pylori Infection - A Pilot Study - Full Text View

Sponsor:	National Taiwan University Hospital
Information provided by:	National Taiwan University Hospital
ClinicalTrials.gov Identifier:	NCT00885417

Purpose

Helicobacter pylori infection has been shown to be associated with the development of gastric cancer and peptic ulcer diseases. Eradication of H. pylori infection could reduce the occurence or recurrence of these diseases. However, it was estimated that 15-20% of patients would fail from first line standard eradication therapy and need second line rescue therapy. About 15-30% of patient would fail from second line therapy and need to be rescued with third line therapy. The commonly used salvage regimens include:

Bismuth based quadruple therapy (combined with ranitidine or proton-pump inhibitor (PPI) plus two antibiotics)
Levofloxacin or moxifloxacin or rifabutin based triple therapy.

However, Bismuth is not available in many countries and the administration method is complex. Its usage is limited by the high pill number and low compliance rate. In recent years, the concept of sequential therapy has been advocated in the treatment of H. pylori infection. The regimen includes a PPI plus amoxicillin for five days, followed by a PPI plus clarithromycin and metronidazole for another five days. The eradication rate in the first line treatment of sequential therapy had been reported to be as high as 90%. More importantly, it has been demonstrated that the eradication rate among patients with clarithromycin-resistant strains could be as high as 89%.

Aims: Therefore, the investigators aim to assess the efficacy of levofloxacin-based sequential therapy as second line therapy for those who fail from one standard eradication therapy.

Condition	Intervention	Phase
H. Pylori Infection	Drug: Cravit-based sequential therapy	Phase IV

Study Type:	Interventional
Study Design:	Treatment, Non-Randomized, Open Label, Single Group Assignment, Efficacy Study

Further study details as provided by National Taiwan University Hospital:

Primary Outcome Measures:

Eradication rate will be evaluated according to Intent-to-treat (ITT) and per-protocol (PP) analyses [ Time Frame: 2009/4/20 ] [ Designated as safety issue: No ]

Estimated Enrollment:	50
Study Start Date:	April 2009
Estimated Study Completion Date:	April 2010
Estimated Primary Completion Date:	April 2010 (Final data collection date for primary outcome measure)

Arms	Assigned Interventions
Cravit-based sequential therapy: Experimental Cravit-based sequential therapy Eligible patients will be treated with (esomeprazole 40mg bid +amoxicillin 1gm bid) for 5 days, followed by (esomeprazole 40mg bid + levofloxacin 250mg bid + metronidazole 500mg bid ) for another 5 days	Drug: Cravit-based sequential therapy Eligible patients will be treated with (esomeprazole 40mg bid +amoxicillin 1gm bid) for 5 days, followed by (esomeprazole 40mg bid + levofloxacin 250mg bid + metronidazole 500mg bid ) for another 5 days

Eligibility

Ages Eligible for Study:	20 Years and older
Genders Eligible for Study:	Both
Accepts Healthy Volunteers:	No

Criteria

Inclusion Criteria:

Patients are aged greater than 20 years who have persistent H. pylori infection after one treatment and are willing to receive second line rescue regimens, respectively, are considered eligible for enrollment.

Exclusion Criteria:

Children and teenagers aged less than 20 years,
History of gastrectomy,
Gastric malignancy, including adenocarcinoma and lymphoma,
Previous allergic reaction to antibiotics (amoxicillin, clarithromycin, levofloxacin) and prompt pump inhibitors (esomeprazole),
Contraindication to treatment drugs,
Pregnant or lactating women, OR
Severe concurrent disease.

Contacts and Locations

Please refer to this study by its ClinicalTrials.gov identifier: NCT00885417

Contacts

Contact: Jyh-Ming Liou, MD

886-2-23123456 ext 63541

dtmed046@pchome.com.tw

Locations

Taiwan
National Taiwan University Hospital
Taipei, Taiwan, 10002

Sponsors and Collaborators

National Taiwan University Hospital

More Information

No publications provided

Responsible Party:	National Taiwan University Hospital ( Jyh-Ming Liou )
Study ID Numbers:	200901041M
Study First Received:	April 20, 2009
Last Updated:	April 21, 2009
ClinicalTrials.gov Identifier:	NCT00885417 History of Changes
Health Authority:	Taiwan: Department of Health

Keywords provided by National Taiwan University Hospital:

Helicobacter pylori
sequential therapy
levofloxacin
clarithromycin

rescue
salvage
treatment failure
For those who fail from one standard eradication therapy for H. pylori infection

Additional relevant MeSH terms:

Communicable Diseases
Infection

ClinicalTrials.gov processed this record on February 08, 2010