Reply to: Minocycline versus tetracycline in bismuth-containing quadruple therapy for Helicobacter pylori rescue treatment: a multicentre, randomized controlled trial

Excerpt

We thank Tomohiro Kurokawa and Tomoharu Kurokawa for their interest in our study [1]. Though the high dizziness rate (44.0%, 81/184) occurred in the minocycline group, mild dizziness was predominant and almost all subjects could tolerate. There were 83.9% (68/81) of subjects with mild dizziness, 13.6% (11/81) of subjects with moderate dizziness, and 2.5% (2/81) of subjects with severe dizziness among dizziness patients. Dizziness occurred every day during eradication treatment and disappeared after cessation of treatment. We achieved excellent eradication rate of 97.5% (79/81) in subjects with dizziness for minocycline group. The adherence was excellent (98.8%, 80/81) as well since they were informed of the high probability of dizziness before treatment. There were two subjects presented to the emergency department with severe dizziness; one subject adhered to medication and the other one discontinued drugs on day 4, and both of them achieved successful eradication of Helicobacter pylori (H. pylori) infection. Moreover, we reported a high metronidazole resistance rate of 89.6%, which was slightly higher than our previous study for salvage H. pylori treatment [2]. Usually, antibiotic resistance reduces efficacy of H. pylori treatment. However, unlike clarithromycin, metronidazole resistance in vitro has a low correlation with in vivo eradication rates and can be partially or completely overcome by addition of bismuth, increasing the dose (≥1500 mg daily) and prolonging the duration (2 weeks) [3‐5], accounting for the high incidence of adverse events in our study as well. Certainly, a good regimen for H. pylori eradication should accomplish satisfactory outcomes with low side effects. Therefore, we also conducted another study to explore the efficacy and tolerability of the lower dosage of minocycline and metronidazole in bismuth-containing quadruple therapy for H. pylori eradication and relevant data are being collected for further analysis. …