Giris ve amaç: Standart üçlü tedavi ile Helicobacter pylori (H. pylori) eradikasyonu saglanmayan olgularda ikinci tedavi ile eradikasyon daha zordur. H. pylori eradikasyon basarisizliklarinda uygulanacak tedavi kombinasyonlari kesin belirlenmemistir. Bu çalismada lansoprazol, amoksisilin ve klaritromisin (LAK) ile yapilan standart üçlü tedavi ile H. pylori eradikasyonu saglanamayan olgularda lansoprazol, ranitidin bizmut sitrat, tetrasiklin ve metronidazolden (LBTM) olusan dörtlü tedavinin etkinligini arastirdik. Gereç ve yöntem: Peptik ülser hastaligi veya nonülser dispepsi nedeniyle standart üçlü LAK tedavisi verilen ve H. pylori eradikasyonu saglanamayan toplam 36 olgu çalismaya alindi. Bu olgulara lansoprazol (2x30 mg), ranitidin bizmut sitrat (2x400 mg), tetrasiklin (4x500 mg) ve metronidazolden (3x500 mg) olusan dörtlü tedavi 14 gün verildi. Tedavinin bitiminden iki ay sonra endoskopik biyopsi ile H. pylori eradikasyonu degerlendirildi. Bulgular: Olgulardan besi tedavi bitiminde kontrole gelmediginden çalisma disi birakildi. Dörtlü tedavi ile H. pylori eradikasyon orani çalismaya alinan tüm olgular degerlendirildiginde %58.3, çalisma sonunda kontrole gelen olgular degerlendirildiginde ise %67.7 saptandi. Sonuç: Bölgemizde standart LAK tedavisi ile H. pylori eradikasyonu saglanamayan olgularda LBMT dörtlü tedavi kombinasyonunun basari oranini oldukça düsük bulduk. Bu durumun ülkemizdeki metronidazol direncinin yüksek seviyelerde olmasi ile açiklanabilecegini düsünmekteyiz. Ülkemizde farkli bölgelerde H. pylorinin antibiyotik direnç durumunu ve tedavi basarisizligi sebeplerini degerlendiren arastirmalara ihtiyaç vardir.
Background/aim: Successful eradication of Helicobacter pylori (H. pylori) infection after failure of standard triple therapy is difficult. There are no guidelines on second-line therapies for H. pylori eradication failures. In the present study we investigated the efficacy of a 14-day quadruple regimen combining lansoprazole, ranitidine bismuth citrate (RBC), tetracycline and metronidazole as rescue treatment for Helicobacter pylori infection after failure of standard triple therapy combining lansoprazole, amoxicillin, clarithromycin (LAC). Materials and methods: A prospective study was designed consisting 36 patients infected with H. pylori and diagnosed with peptic ulcer or non-ulcer dyspepsia in whom triple therapy with LAC had failed. The patients were treated with quadruple therapy including lansoprazole, 30 mg twice daily, RBC, 400 mg twice daily, tetracycline, 500 mg four times daily, and metronidazole, 500 mg three times daily, for 14 days. Two months after completion of therapy, endoscopic biopsy evaluation was performed to confirm eradication. Results: Five cases who did not attend to the appointment were excluded from the study. With quadruple therapy, the H. pylori eradication rates were 58.3% by intention-to-treat analysis and 67.7% by per protocol analysis. Conclusion: The success rate of quadruple therapy with LBTM was found to be low in patients in whom standard triple therapy had failed in western Blacksea region. This finding may be explained by higher rates of metronidasole resistance in our country. We conclude that further studies about the drug resistance rates and explanation of reasons for treatment failure must be carried out.