Vonoprazan improves the efficacy of Helicobacter pylori eradication therapy with a regimen consisting of clarithromycin and metronidazole in patients allergic to penicillin. Issue 3 (18th January 2017)

• Record Type: Journal Article
• Authors: Ono, Shoko; Kato, Mototsugu; Nakagawa, Soichi; Mabe, Katsuhiro; Sakamoto, Naoya
• Is Part Of: Helicobacter. Volume 22:Issue 3(2017)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2017-01-18
• Subjects: eradication therapy -- Helicobacter pylori -- penicillin allergy -- vonoprazan; Helicobacter -- Periodicals; Helicobacter infections -- Periodicals; Stomach -- Diseases -- Periodicals; 616.3301405
• DOI: 10.1111/hel.12374
• Languages: English
• ISSNs: 1083-4389

Abstract

Abstract: Background: Although all Helicobacter pylori ( H. pylori )‐positive patients should receive eradication therapy, the therapy is a challenge for patients allergic to penicillin. There have been a few reports on the efficacy of eradication therapy for such patients. Objective: To analyze the efficacy of vonoprazan or proton pump inhibitor (PPI)‐based 7‐day triple therapy in patients allergic to penicillin. Materials and Methods: A total of 88 consecutive patients allergic to penicillin who received H. pylori eradication therapy were retrospectively analyzed. Thirty‐one patients had a history of failed eradication therapy. Four 7‐day regimens were prescribed during the study period: clarithromycin‐metronidazole‐PPI (13 patients), clarithromycin‐metronidazole‐vonoprazan (14 patients), metronidazole‐sitafloxacin‐PPI (44 patients) and metronidazole‐sitafloxacin‐vonoprazan (17 patients). A 13 C‐urea breath test was used for confirmation of eradication, and efficacy of eradication was evaluated by "intention‐to‐treat" analysis and "per‐protocol" analysis. Results: Intention‐to‐treat and per‐protocol eradication rates were 46.2%/54.6% for patients who received clarithromycin‐metronidazole‐PPI, 92.9/92.9% for patients who received clarithromycin‐metronidazole‐vonoprazan, 100/100% for patients who received metronidazole‐sitafloxacin‐PPI and 88.2/93.8% for patients who received metronidazole‐sitafloxacin‐vonoprazan. For first eradication, vonoprazan significantly raised the intention‐to‐treat efficacy of the triple therapy including clarithromycin‐metronidazole (vonoprazan: 92.9%, PPI: 46.2%, P =.0128). A 7‐day regimen consisting of metronidazole and sitafloxacin was effective for patients allergic to penicillin with or without past failure of eradication. Conclusion: For first eradication in patients allergic to penicillin, a 7‐day triple therapy consisting of clarithromycin, metronidazole and vonoprazan could be a candidate eradication regimen.