Efficacy of Tailored Helicobacter pylori Eradication Treatment Based on Clarithromycin Susceptibility and Maintenance of Acid Secretion. Issue 4 (1st April 2014)

• Record Type: Journal Article
• Authors: Sugimoto, Mitsushige; Uotani, Takahiro; Sahara, Shu; Ichikawa, Hitomi; Yamade, Mihoko; Sugimoto, Ken; Furuta, Takahisa
• Is Part Of: Helicobacter. Volume 19:Issue 4(2014:Aug.)
• Page Start: 312
• Page End: 318
• Publication Date: 2014-04-01
• Subjects: Helicobacter -- Periodicals; Helicobacter infections -- Periodicals; Stomach -- Diseases -- Periodicals; 616.3301405
• DOI: 10.1111/hel.12128
• Languages: English
• ISSNs: 1083-4389

Abstract

<abstract abstract-type="main" id="hel12128-abs-0001"> <title>Abstract</title> <sec id="hel12128-sec-0001" sec-type="section"> <title>Background</title> <p>Insufficient acid inhibition during <italic>Helicobacter pylori</italic> eradication treatment and bacterial resistance to antibiotics often causes eradication failure. Four times daily dosing (q.i.d.) of a proton‐pump inhibitor (PPI) achieves potent acid inhibition, suggesting its potential usefulness as a regimen for eradicating <italic>H. pylori</italic> infection. Therefore, a tailored eradication regimen based on antibiotic susceptibility and maintenance of acid inhibition should have a high success rate. We investigated the efficacy of such treatment based on clarithromycin (CAM) susceptibility.</p> </sec> <sec id="hel12128-sec-0002" sec-type="section"> <title>Methods</title> <p>Using 153 <italic>H. pylori</italic>‐positive Japanese patients, we investigated the efficacy of tailored eradication strategy: (1) Patients infected with CAM‐sensitive <italic>H. pylori</italic> were treated with a PPI (rabeprazole 10 mg q.i.d.), amoxicillin 500 mg q.i.d., and CAM 200 mg b.i.d. (n = 89), and (2) patients infected with CAM‐resistant were given the same doses of rabeprazole and amoxicillin and metronidazole 250 mg b.i.d. (n = 64) for 1 week.</p> </sec> <sec id="hel12128-sec-0003" sec-type="section"> <title>Results</title> <p>In the tailored regimen group, the overall eradication rate was 96.7% (95% CI: 92.5–98.9%, 148/153) in the intention‐to‐treat (ITT) analysis and 97.4% (93.4–99.3%, 148/152) in the PP analysis. The eradication rates for the CAM‐ and metronidazole‐based treatments were similar (95.5% and 98.4%, respectively, <italic>p</italic> = .400). The tailored treatment achieved a high eradication rate in CYP2C19 rapid metabolizers who were a resistance genotype for PPI treatment (94.3% (86.0–98.4%, 66/70)).</p> </sec> <sec id="hel12128-sec-0004" sec-type="section"> <title>Discussion</title> <p>A tailored <italic>H. pylori</italic> eradication regimen based on CAM susceptibility and maintaining acid secretion (rabeprazole 10 mg q.i.d.) is useful because it can achieve an eradication rate exceeding 95%, irrespective of eradication history, thus overcoming differences among CYP2C19 genotypes.</p> </sec> </abstract>