Table 2.
Antimicrobial therapies used in third-line therapy studies.
| Study | First-line treatment | Second-line treatment | Drug resistance after the second treatment failure | Susceptibility-guided third-line treatment | N | Treatment duration |
|---|---|---|---|---|---|---|
| Cammarota et al. [2004] | PPI b.d., A 1 g b.d., M 250 mg q.d. or TI 500 mg b.d. for 7 days (n = 37) | PPI (double dose per day), A 1 g, C 250 or 500 mg b.d. for 7 days (n = 27) PPI (double dose per day), A 1 g, L 500 mg b.d. for 7 days (n = 7) O 20 mg b.d., B 120 mg q.d.s., A 1 g b.d., TE 500 mg q.d.s. for 7 days (n = 3) |
M: 100% C: 95% L: 31% TE: 5% A: 0% |
A and TE sensitive: B 120 mg q.d,s., O 20 mg b.d., A 1 g b.d., D 100 mg b.d. |
89 | 7 days |
| PPI, A 1 g, C 250 or 500 mg b.d. for 7 days (n = 34) | PPI (double dose per day), B 120 mg q.d.s., M 250 mg q.d.s or TI 500 mg b.d., TE 500 mg q.d.s. for 7 days (n = 28) PPI (double dose per day), A 1 g, L 500 mg b.d. for 7 days (n = 6) |
TE, M and C resistant: O 20 mg b.d., A 1 g b.d., L 500 mg b.d. |
4 | 7 days | ||
| PPI b.d., A 1 g, L 500 mg b.d. for 7 days (n = 23) | PPI (double dose per day), A 1 g, C 250 or 500 mg b.d. for 7 days (n = 11) O 20 mg b.d., B 120 mg q.d.s., A 1 g b.d., TE 500 mg q.d.s. for 7 days (n = 2) PPI (double dose per day), B 120 mg q.d.s., M 250 mg q.d.s or TI 500 mg b.d., TE (500 mg q.d.s for 7 days (n = 10) |
TE, M and L resistant: O 20 mg, A 1 g, C 500 mg b.d. |
1 | 7 days | ||
| Gasbarrini et al. [2000] | PPI, TI, C 7 days (n = 58) | RBC, A C 7 days (n = 58) | AZ: 68% ER: 62% C: 56% M and TI 56% TE 12% A 0% |
PPI, B, A, TE | 26 | Not reported |
| PPI, B, A, M | 9 | |||||
| PPI, B, TE, M | 4 | |||||
| Liou et al. [2013] | 100% (131/131) received C and 79.1% (102/129) L in first or in second line | 23S rRNA mutation (tissue) 78.9% (101/128) 23S rRNA mutation (strain) 85.7% (84/98) Gyrase A mutation (tissue) 41.3% (52/126) Gyrase A mutation (strain) 42.9% (42/98) L resistance 46.9% (45/96) A resistance 9.4% (9/96) M resistance 58.3% (56/96) TE resistance 3.2% (3/93) C resistance 86.5% (83/96) |
23S rRNA wild-type: ES 40 mg, A 1 g, M 500 mg, C 500 mg b.d. |
19 | ES, A 7 days followed by M, C 7 days | |
| 23S rRNA mutant-type and gyrA wild-type: ES 40 mg, A 1 g, M 500 mg, L 250 mg b.d. |
51 | ES, A 7 days followed by M, LE 7 days | ||||
| 23S rRNA mutant-type and gyrA mutant-type: ES 40 mg, A 1 g, M 500 mg, TE 500 mg b.d. |
65 | ES, A 7 days followed by M, TE 7 days | ||||
| Vicente et al. [2002] | Not reported | Not reported | M resistance 44% (18/41) C resistance 52% (21/41) Both C and M resistance 19% (5/41) A 0% TE 0% |
Susceptible to C and M: O 20 mg b.d., B 120 mg q.d., TE 500 mg q.d., C 500 mg b.d. |
9 | 14 days |
| Resistant to C: O 20 mg b.d., B 120 mg q.d., TE 500 mg q.d., A 1 g b.d. |
13 | 14 days | ||||
| Resistant to M: O 20 mg b.d., B 120 mg q.d., TE 500 mg q.d., C 500 mg b.d./ A 1 g b.d. |
10 | 14 days | ||||
| M and C resistant and penicillin allergy: O 20 mg b.d., B 120 mg q.d., TE 500 mg q.d., CI 500 mg b.d. |
8 | 14 days | ||||
PPI, proton pump inhibitor; A, amoxicillin; C, clarithromycin; L, levofloxacin; M, metronidazole; TI, tinidazole; b.d., twice a day; q.d.s., four times a day; TE, tetracycline; B, bismuth; O, omeprazole; D, doxycycline; RBC, ranitidine bismuth citrate; AZ, azithromycin; ER, erythromycin; ES, esomeprazole; SGT, susceptibility-guided therapy.