An optimized clarithromycin-free 14-day triple therapy for Helicobacter pylori eradication achieves high cure rates in Uruguay
| Autor: | María Di Pace, Xavier Calvet, Ximena Pazos, Jordi Sánchez-Delgado, Henry Cohen, Henia Balter, Cristina Dacoll, Gabriela Sandoya |
|---|---|
| Rok vydání: | 2016 |
| Předmět: |
medicine.medical_specialty
Nausea Urea breath test Gastroenterology Esomeprazole 03 medical and health sciences 0302 clinical medicine Clarithromycin Internal medicine medicine Hepatology medicine.diagnostic_test biology business.industry Amoxicillin Helicobacter pylori biology.organism_classification Surgery Metronidazole 030220 oncology & carcinogenesis 030211 gastroenterology & hepatology Gastritis medicine.symptom business medicine.drug |
| Zdroj: | Gastroenterologia y hepatologia. 40(7) |
| ISSN: | 0210-5705 |
| Popis: | Background Strong acid inhibition increases cure rates with triple therapy and 14-day are more effective than 7-day treatments. The combination of amoxicillin plus metronidazole at full doses has been shown to overcome metronidazole resistance and to achieve good eradication rates even in patients harboring resistant strains. No previous studies have been reported in Latin-America with this optimized triple-therapy scheme. Aims The aim of the present study was to assess the eradication rate and tolerance of a new first-line treatment regimen associating strong acid inhibition, amoxicillin and metronidazole. Methods Patients from the Clinica de Gastroenterologia of the Hospital de Clinicas (Montevideo, Uruguay) were included. Hp status was mainly assessed by at least one of the following: histologyor urea breath test (UBT). A 14-day treatment was prescribed comprising esomeprazole 40 mg twice a day plus amoxicillin 1 g and metronidazole 500 mg, both three times a day. H. pylori cure was assessed by UBT. Results Forty-one patients were enrolled. Mean age was 53.3 ± 13 years and 17.1% of patients were male. Main indications for treatment were: functional dyspepsia (27.5%), gastritis (45%), gastric or duodenal erosions (20%), gastric ulcer (5%) and intestinal metaplasia (2.5%). H. pylori eradication was achieved in 33 of the 37 patients who returned for follow-up. Eradication rates were 80.5% (95% CI: 68.4–92.6) by intention-to-treat (ITT) analysis and 89.2% (95% CI; 79.2–99.2) per protocol (PP). No major side effects were reported; 26 patients (65.8%) complained of mild side effects (nausea, diarrhea and headache). Conclusions Cure rates of this triple therapy including esomeprazole, amoxicillin and metronidazole were 81% per ITT and the treatment was well tolerated. These optimal results with a simple clarithromycin-free triple therapy are better than described for standard triple therapy but there is still room for improvement to reach the desired target of 90% per ITT. |
| Databáze: | OpenAIRE |
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