The dual therapy with 4 times daily dosing of rabeprazole and amoxicillin as the 3rd rescue regimen for eradication of H. pylori.

Backgrounds/aims: Most of patients who are refractory to usual standard eradication therapies for H. pylori infection have rapid metabolizer genotype of CYP2C19 and are infected with resistant strains to several antimicrobial agents. However, most of H. pylori strains are sensitive to amoxicillin. We tested whether dual therapy with the 4 times daily dosing of rabeprazole and amoxicillin was effective as the 3rd rescue regimen for eradication of H. pylori.

Methodology: 49 patients who failed in eradication of H. pylori after two (1st: proton pump inhibitor (PPI)/amoxicillin/clarithromycin and 2nd: PPI/amoxicillin/metronidazole) were enrolled to the study. They were treated with rabeprazole 10 mg q.i.d. and amoxicillin 500 mg q.i.d. for 2 weeks. At 4 weeks after the treatment, they underwent the [13C]-urea breath test. When the result of [13C]-urea breath test was negative, they underwent the endoscopy and the successful eradication was confirmed by rapid urease test.

Results: All patients completed the treatment. The eradication rate was 87.8% (43/49) (95% CI = 75.2%-95.4%). No undesirable severe adverse events were observed during the study period.

Conclusions: The dual therapy with 4 times daily dosing of rabeprazole and amoxicillin is well tolerated and effective as the 3rd rescue regimen for eradication of H. pylori.