Ten‐day triple therapy versus sequential therapy versus concomitant therapy as first‐line treatment for Helicobacter pylori infection. Issue 7 (July 2015)

• Record Type: Journal Article
• Authors: Ang, Tiing Leong; Fock, Kwong Ming; Song, Mingjun; Ang, Daphne; Kwek, Andrew Boon Eu; Ong, Jeannie; Tan, Jessica; Teo, Eng Kiong; Dhamodaran, Subbiah
• Is Part Of: Journal of gastroenterology and hepatology. Volume 30:Issue 7(2015:Jul.)
• Page Start: 1134
• Page End: 1139
• Publication Date: 2015-07
• Subjects: Gastroenterology -- Periodicals; Digestive organs -- Diseases -- Periodicals; Liver -- Diseases -- Periodicals; Gastroenterology -- Periodicals; Liver Diseases -- Periodicals; 616.33
• DOI: 10.1111/jgh.12892
• Languages: English
• ISSNs: 0815-9319

Abstract

<abstract abstract-type="main"> <title>Abstract</title> <sec id="jgh12892-sec-0001" sec-type="section"> <title>Background and Aim</title> <p>Clarithromycin‐based triple therapy (TT) is the first‐line treatment for <italic>Helicobacter pylori</italic> infection in Singapore. There is awareness that TT may no longer be effective due to increased clarithromycin resistance rates. Sequential therapy (ST) and concomitant therapy (CT) are alternative treatment regimens. This study aimed to compare the efficacy of 10‐day TT, ST, and CT as first‐line treatment for <italic>H. pylori</italic> infection.</p> </sec> <sec id="jgh12892-sec-0002" sec-type="section"> <title>Methods</title> <p>A randomized study conducted in a teaching hospital. Patients aged 21 years and older with newly diagnosed <italic>H. pylori</italic> infection were randomized to 10‐day TT, ST, or CT. Treatment outcome was assessed by 13‐carbon urea breath test at least 4 weeks after therapy. Intention to treat (ITT), modified ITT (MITT), and per protocol (PP) analyses of the eradication rates were performed.</p> </sec> <sec id="jgh12892-sec-0003" sec-type="section"> <title>Results</title> <p>A total of 462 patients were enrolled (ST: 154; TT 155; CT 153). Patient demographics were similar. Eradication rates for ST <italic>versus</italic> TT <italic>versus</italic> CT: ITT analysis: 84.4% <italic>versus</italic> 83.2% <italic>versus</italic> 81.7% (<italic>P</italic> = not significant [NS]); MITT analysis: 90.3% <italic>versus</italic> 92.1% <italic>versus</italic> 94.7% (<italic>P</italic> = NS); PP analysis: 94.1% <italic>versus</italic> 92.8% <italic>versus</italic> 95.4% (<italic>P</italic> = NS). Antibiotic resistance rates for amoxicillin, clarithromycin, and metronidazole were 4.7%, 17.9%, and 48.1%, respectively. Dual clarithromycin and metronidazole resistance occurred in 7.5%. Dual resistance and lack of compliance were predictors of treatment failure.</p> </sec> <sec id="jgh12892-sec-0004" sec-type="section"> <title>Conclusions</title> <p>TT, ST, and CT all achieved eradication rates above 80% on ITT and above 90% on MITT and PP analyses. Dual resistance and lack of compliance were predictors of treatment failure (clinicaltrials.gov: NCT02092506).</p> </sec> </abstract>