A Two-Week Nitazoxanide-Based Quadruple Treatment as a Rescue Therapy for Helicobacter Pylori Eradication

Abstract

Introduction: Helicobacter pylori is the most common prevalent chronic human bacterial infection estimated in 50% of the global population but only induces clinical diseases in 10-20% of infected individuals. These include peptic ulcers, acute and atrophic gastritis, intestinal metaplasia, gastric adeno-carcinoma and gastric B-cell lymphoma. H. pylori infection has become highly resistant to traditional first-line treatment regimens because of antibiotic resistance coupled with poor patient compliance with completing the treatment course. Many clinical studies proved that nitazoxanide (NTZ) was found to be well tolerated by humans, with an encouraging rate of eradication when it was administered with omeprazole. Aims: The aim of the work is to compare between the efficacy of traditional triple therapy and nitazoxanide-based quadruple therapy in treatment of H. pylori and to evaluate the efficacy of nitazoxanide-based regimens as a rescue regimen for H. pylori eradication in resistant patients. Methodology: This study was carried out on 85 Helicobacter pylori (H. pylori) infected patients; Patients were classified in to 3 groups: Group 1: 60 patients with positive H. pylori Ag taking 14 days triple therapy composed of amoxicillin (1 gm twice daily), clarithromycin (500 mg twice daily) and omeprazole (40 mg once daily).; Group 2: 25 patients with positive H. pylori Ag (naive: not having previously taken or received a particular treatment for H. pylori) taking 14 days quadruple therapy composed of nitazoxanide (500 mg twice daily), in addition to triple therapy.; Group 3: 22 patients with positive H. pylori Ag after treatment (resistant for triple therapy from group 1) taking 14 days nitazoxanide-based quadruple therapy. Results: This work recorded the best results for H. pylori eradication (92%) in group II who received nitazoxanide based quadruple therapy compared with group I eradication rate (63.3%), who received traditional triple therapy regimen and better results (77.3%) in group III (resistant patients from group I). Conclusion: This study could state that, using nitazoxanide can overcome traditional triple therapy resistance; in addition to its efficacy in treating naive patients who didn’t take any medical treatment for H. pylori. Recommendations: Nitazoxanide (NTZ) based regimen namely NTZ/ clarithromycin / PPIs and amoxicillin is a recommended H. pylori therapeutic regimen in our community.