Efficacy of triple therapy with esomeprazole, amoxicillin, and sitafloxacin as a third-line Helicobacter pylori eradication regimen

• A third-line Helicobacter pylori eradication regimen is not established in Japan.
• Esomeprazole is the latest proton pump inhibitor (PPI) approved in Japan, and has superior acid suppression.
• The effect of third-line therapy with esomeprazole and sitafloxacin was examined.
• Esomeprazole and sitafloxacin-based third-line therapy showed an eradication rate of 83%.
• Adverse events were comparable to those of former PPI-based therapies.

SummaryObjectiveTo examine the efficacy of third-line Helicobacter pylori eradication therapy with esomeprazole, amoxicillin, and sitafloxacin for patients with clarithromycin- and metronidazole-based first- and second-line therapy failure.MethodsThirty patients with first- and second-line H. pylori eradication failure were treated prospectively with esomeprazole 20 mg twice daily, amoxicillin 750 mg twice daily, and sitafloxacin 100 mg twice daily for 7 days. After 8–12 weeks, the outcome of eradication therapy was assessed by 13C-urea breath test or stool antigen test.ResultsAll 30 patients completed the study. Eradication was successful in 25 patients and the eradication rate was 83% in the intention-to-treat and per-protocol analyses. No specific or significant adverse events were recorded in the 30 patients. Patient characteristics such as sex, body mass index, and pepsinogen I/II ratio did not differ between patients who were treated successfully and those who were not treated successfully.ConclusionsThird-line H. pylori eradication therapy with esomeprazole, amoxicillin, and sitafloxacin is as safe and effective as previously reported sitafloxacin-based triple therapy.