Risks Of Failure In Helicobacter Pylori Eradication By Lansoprazole, Amoxicillin, And Metronidazole Triple Therapy In Japan

patients who underwent formal testing, 4 treatment naïve patients were found to be allergic to penicillin (1 low-positive RAST, 3 delayed reactions to oral challenge) and were treated successfully with PPI-metronidazole-clarithromycin (3 patients), or quadruple therapy (1 patient).Of the 16 patients with negative testing, 9 were treatment naïve and all were given PPI-amoxicillin-clarithromycin (PPI-AC) with success in 8; the other patient responded to salvage treatment with PPI-amoxicillin-rifabutin (PPI-AR).One patient developed a rash.Of the 7 patients with prior eradication failure(s) all achieved eradication with tailored penicillin containing therapies (6 with PPI-AR, 1 with PPI-AC) with no allergic adverse events.Conclusions: Patient reported penicillin allergy is often unreliable and hampers H. pylori treatment.Formal testing carries a risk of unpredictable delayed reactions but allows rational choices for first and salvage therapies, which in this small cohort led to eradication success in all patients.