Clarithromycin Versus Metronidazole as First-line Helicobacter pylori Eradication. Issue 6 (July 2015)

• Record Type: Journal Article
• Authors: Nishizawa, Toshihiro; Maekawa, Takama; Watanabe, Noriko; Harada, Naohiko; Hosoda, Yasuo; Yoshinaga, Masahiro; Yoshio, Toshiyuki; Ohta, Hajime; Inoue, Syuuji; Toyokawa, Tatsuya; Yamashita, Haruhiro; Saito, Hiroki; Kuwai, Toshio; Katayama, Shunsuke; Masuda, Eiji; Miyabayashi, Hideharu; Kimura, Toshio; Nishizawa, Yuko; Takahashi, Masahiko; Suzuki, Hidekazu
• Is Part Of: Journal of clinical gastroenterology. Volume 49:Issue 6(2015)
• Publication Date: 2015-07
• Subjects: Gastroenterology -- Periodicals; Digestive organs -- Diseases -- Periodicals; Gastroenterology -- Periodicals; Digestive organs -- Diseases; Gastroenterology; Periodicals; Periodicals; 616.33005
• DOI: 10.1097/MCG.0000000000000165
• Languages: English
• ISSNs: 0192-0790

Abstract

<abstract> <title> <x xml:space="preserve">Abstract</x> </title> <sec> <title>Background:</title> <p> <italic>Helicobacter pylori</italic> eradication rates achieved with a first-line regimen of clarithromycin (CLR) combined with amoxicillin (AMX) and a proton pump inhibitor have recently fallen to ⩽80% because of the increasing incidence of CLR resistance in Japan. This randomized multicenter trial aimed to compare the eradication success of 2 first-line triple therapy regimens: rabeprazole, amoxicillin, and clarithromycin (RAC) versus rabeprazole, amoxicillin, and metronidazole (RAM).</p> </sec> <sec> <title>Methods:</title> <p>A total of 124 consecutive patients infected with <italic>H. pylori</italic> were randomized into one of two 7-day therapeutic regimens: RAC (n=60) or RAM (n=64). Eradication was confirmed by the <sup>13</sup>C-urea breath test. Adverse effects were also assessed.</p> </sec> <sec> <title>Results:</title> <p>Intention-to-treat and per protocol <italic>H. pylori</italic> eradication rates were 73.3%/77.2% in the RAC group and 90.6%/93.5% in the RAM group. The eradication rate of RAM therapy was significantly higher than that of RAC therapy. CLR, metronidazole, and AMX resistance was found in 36.2%, 2.1%, and 0% of patients, respectively. In addition, no relevant differences in adverse effects were observed.</p> </sec> <sec> <title>Conclusions:</title> <p>Metronidazole-based therapy (RAM) was superior to standard CLR-based therapy (RAC) for first-line <italic>H. pylori</italic> eradication. This reflects the progressive increase in CLR resistance observed in Japan.</p> </sec> </abstract>