Seven-Day Bismuth-based Quadruple Therapy as an Initial Treatment for Helicobacter pylori Infection in a High Metronidazole Resistant Area
| Autor: | Varocha Mahachai, Hatainuch Prapitpaiboon, Ratha-Korn Vilaichone, Juraiwan Namtanee, Pornpen Gamnarai, Arti Wongcha-um, Supakarn Chaithongrat |
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| Rok vydání: | 2015 |
| Předmět: |
Male
Cancer Research medicine.medical_specialty Epidemiology medicine.drug_class Urea breath test Antibiotics Rapid urease test Gastroenterology Bismuth subsalicylate Helicobacter Infections Metronidazole Internal medicine Drug Resistance Bacterial Organometallic Compounds Humans Medicine Pantoprazole Helicobacter pylori medicine.diagnostic_test biology business.industry Public Health Environmental and Occupational Health Middle Aged Amoxicillin Prognosis Thailand biology.organism_classification Salicylates Anti-Bacterial Agents Surgery Breath Tests Oncology Drug Therapy Combination Female business Bismuth Follow-Up Studies medicine.drug |
| Zdroj: | Asian Pacific Journal of Cancer Prevention. 16:6089-6092 |
| ISSN: | 1513-7368 |
| Popis: | Background: The prevalence of metronidazole-resistant H. pylori is almost 50% in Thailand which severely limits the use of this drug for eradication therapy. The aims of this study were to evaluate the efficacy and safety profiles of 7-day bismuth-based quadruple therapy including metronidazole as an initial treatment for H. pylori infection in a high metronidazole resistance area. Materials and Methods: This study was performed at Thammasat University Hospital and King Chulalongkorn Memorial Hospital during January 2009 to October 2010. Patients with non-ulcer dyspepsia (NUD) with active H. pylori infection were assigned to receive seven days of quadruple therapy (pantoprazole 40 mg bid, bismuth subsalicylate 1,048 mg bid, amoxicillin 1 gm bid and metronidazole 400 mg tid). H. pylori infection was defined as positive H. pylori culture or two positive tests (rapid urease test and histology). Antibiotic susceptibility test for metronidazole by Epsilometer test (E-test) was performed in all positive cultures. At least four weeks after treatment, 13 C urea breath test ( 13 C-UBT) was performed to confirm H. pylori eradication. Results: A total of 114 patients were enrolled in this study, 50 males and 64 females with a mean age of 49.8 years. All 114 patients had a diagnosis of NUD. Overall eradication as confirmed by negative 13 C-UBT was achieved in 94 out of 114 patients (82.5%). 44 patients had positive cultures and success for E-test. In vitro metronidazole resistance was observed in 22/44 (50%) patients. Eradication rate in patients with metronidazole resistant strains was 16/22 (72.7%) and 20/22 (90.1%) with metronidazole sensitive strains (72.7% vs 90.1%, p-value=0.12; OR=3.75 [95%CI=0.6-31.5]). Minor adverse reactions included nausea, bitter taste, diarrhea and black stools but none of the patients dropped out from the study. Conclusions: Initial treatment with 7-day bismuth-based quadruple therapy including metronidazole, amoxycillin and pantoprazole is highly effective and well tolerated for metronidazole-sensitive H. pylori infections. However, the efficacy markedly decline with metronidazole resistance. Longer duration of this regimen might be required to improve the eradication rate and larger multi-center studies are needed to confirm this hypothesis. |
| Databáze: | OpenAIRE |
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