Nitazoxanide Based New Regimens versus Metronidazole Standard Quardable Regimen as Rescue Therapy in Treatment of Resistant H. Pylori gastritis

Abstract Background Helicobacter pylori (H. pylori) is a small, Gram-negative spirochete inhabiting the mucous layer overlying the gastric epithelial cells in humans. It is the most common prevalent chronic human bacterial infection estimated in 50% of the global population Aim of the Work This study aimed to evaluate the efficacy of nitazoxanide and doxycycline as a new regimen in treatment of H.pylori Patients and Methods A Prospective observational cohort study for each patient the time for antibiotic therapy for two weeks and continue PPI therapy for three months. Results In this study we found that there is insignificant difference between both studied groups as regards demographic data. This table shows that there is insignificant difference between both studied groups as regards smoking, chronic illness, main complaint and pelvic-abd US. In this study we demonstrated that there is significant difference between both studied groups as regards PLT and INR. In study in our hands, the eradication rates were found to be higher in LOAD therapy group compared to Concomitant therapy group (83.3% vs. 71.4%), Also there is insignificant difference between both studied groups as regards outcome (P = 0.03) In this thesis we found that increased age is independently associated with higher probability of cure (negative Ag in stool). Conclusion We concluded that LOAD therapy is preferable to clarithromycin-contained triple therapy in H. pylori infection eradication particularly in countries like Egypt with great clarithromycin resistance. This is at least until we can get the bismuth in our country. Recently, the increasing concepts about levofloxacin resistance and decreasing efficacy as a second line treatment directed us towards thinking in levofloxacin contained quadruple therapy including doxycycline and NTZ as alternative line of regimen therapy for better H. pylori eradication in our country. Further studies are needed on larger scale of patients, and culture and sensitivity tests are frequently required to evaluate the resistant emergent bacteria. Although culture and sensitivity might not be carried out, the detection of mutations by molecular methods provides an alternative way in which we can relay in the future.