Improved Efficacy of Proton Pump Inhibitor – Amoxicillin – Clarithromycin Triple Therapy for Helicobacter pylori Eradication in Low Clarithromycin Resistance Areas or for Tailored Therapy. Issue 4 (29th January 2013)

• Record Type: Journal Article
• Authors: Prasertpetmanee, Sanchai; Mahachai, Varocha; Vilaichone, Ratha‐korn
• Is Part Of: Helicobacter. Volume 18:Issue 4(2013:Aug.)
• Page Start: 270
• Page End: 273
• Publication Date: 2013-01-29
• Subjects: Helicobacter -- Periodicals; Helicobacter infections -- Periodicals; Stomach -- Diseases -- Periodicals; 616.3301405
• DOI: 10.1111/hel.12041
• Languages: English
• ISSNs: 1083-4389

Abstract

<abstract abstract-type="main" id="hel12041-abs-0001"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="hel12041-sec-0001" sec-type="section"> <title>Objective</title> <p>Standard triple therapy for <italic>Helicobacter pylori</italic> eradication is no longer effective as an empiric choice in most areas. Even in low clarithromycin resistance areas, results ≥95% are infrequently achieved. This study was designed to search for a version of standard triple therapy for use low prevalence areas or as tailored therapy that is highly effective irrespective of CYP2C19 genotype.</p> </sec> <sec id="hel12041-sec-0002" sec-type="section"> <title>Design</title> <p>Two prospective pilot single center studies were performed in Thailand. <italic>H. pylori</italic>‐infected subjects were randomized to 7‐ or 14‐day regimens using a high‐dose proton pump inhibitor (PPI) triple therapy consisting of lansoprazole (60 mg) twice daily, amoxicillin 1 g twice daily, and long‐acting clarithromycin MR 1 g once daily. <italic>H. pylori</italic> was defined as positive <italic>H. pylori</italic> culture; or two positive tests (rapid urease test and histology); CYP2C19 genotyping was performed. <italic>H. pylori</italic> eradication was evaluated by <sup>13</sup>C‐UBT 4 or more weeks after treatment.</p> </sec> <sec id="hel12041-sec-0003" sec-type="section"> <title>Results</title> <p>Hundred and ten subjects were enrolled (55 each to the 7‐ and 14‐day regimens). Antibiotic susceptibility testing (25 strains) showed 40% metronidazole resistance but no clarithromycin resistance. CYP2C19 genotyping (64 subjects) revealed 56.3% rapid metabolizer, 29.7% intermediate metabolizer, and 14% poor metabolizer. The eradication rate with the 14‐day regimen was 100% (95% CI = 93.5–100%) and 92.7% (95% CI = 82–97%) with the 7‐day regimen. The difference was related to improved eradication at 14 days in rapid metabolizers (i.e. 100 vs 88.2%).</p> </sec> <sec id="hel12041-sec-0004" sec-type="section"> <title>Conclusion</title> <p>Triple therapy using a 14‐day high‐dose PPI and long‐acting clarithromycin provided an excellent cure rate (100%) regardless of the CYP2C19 genotype.</p> </sec> </abstract>