BACKGROUND: Triple therapy with proton pump inhibitor, clarithromycin and amoxicillin has recently been proposed in Maastricht as first-line treatment for H. pylori infection. AIM: To determine predictors of unsuccessful eradication. METHODS: Two hundred and forty-eight patients underwent endoscopy with biopsies for rapid urease test, histology and culture with antibiotic susceptibility tests, and 13C-UBT. All infected patients were given pantoprazole (40 mg b.d.), clarithromycin (500 mg b.d.) and amoxicillin (1 g b.d.) for 1 week. Eradication was assessed by UBT at 4-6 weeks after therapy. RESULTS: One hundred and sixty-two of 248 patients (65%) were infected. Culture was positive in 144 (89%). Prevalence rates of metronidazole, clarithromycin and amoxicillin resistance were 14, 8 and 3%, respectively. Eradication rates (95% CI) were 63% (54.7-70.6) by intention-to-treat analysis and 67% (59.4-75.4) by per protocol analysis. Drug compliance was excellent and side-effects were mild. Age > or = 45 years (OR: 2.35, CI: 1.30-4.25), smoking (OR: 1.37, CI 1.01-1.87) and high pre-treatment UBT results (OR: 1.36, CI: 1.08-1.72) were independent predictors of eradication failure. Gender, endoscopic findings, alcohol intake, and clarithromycin and amoxicillin resistance did not predict treatment failure. CONCLUSION: Despite the low prevalence of primary antibiotic resistance in our geographical area, triple therapy with pantoprazole, amoxicillin and clarithromycin achieves low eradication rates. Smoking, age and pre-treatment UBT results are predictors of potential eradication failure.
BACKGROUND: Triple therapy with proton pump inhibitor, clarithromycin and amoxicillin has recently been proposed in Maastricht as first-line treatment for H. pyloriinfection. AIM: To determine predictors of unsuccessful eradication. METHODS: Two hundred and forty-eight patients underwent endoscopy with biopsies for rapid urease test, histology and culture with antibiotic susceptibility tests, and 13C-UBT. All infectedpatients were given pantoprazole (40 mg b.d.), clarithromycin (500 mg b.d.) and amoxicillin (1 g b.d.) for 1 week. Eradication was assessed by UBT at 4-6 weeks after therapy. RESULTS: One hundred and sixty-two of 248 patients (65%) were infected. Culture was positive in 144 (89%). Prevalence rates of metronidazole, clarithromycin and amoxicillin resistance were 14, 8 and 3%, respectively. Eradication rates (95% CI) were 63% (54.7-70.6) by intention-to-treat analysis and 67% (59.4-75.4) by per protocol analysis. Drug compliance was excellent and side-effects were mild. Age > or = 45 years (OR: 2.35, CI: 1.30-4.25), smoking (OR: 1.37, CI 1.01-1.87) and high pre-treatment UBT results (OR: 1.36, CI: 1.08-1.72) were independent predictors of eradication failure. Gender, endoscopic findings, alcohol intake, and clarithromycin and amoxicillin resistance did not predict treatment failure. CONCLUSION: Despite the low prevalence of primary antibiotic resistance in our geographical area, triple therapy with pantoprazole, amoxicillin and clarithromycin achieves low eradication rates. Smoking, age and pre-treatment UBT results are predictors of potential eradication failure.
Authors: Jae Jin Hwang; Dong Ho Lee; Ae-Ra Lee; Hyuk Yoon; Cheol Min Shin; Young Soo Park; Nayoung Kim Journal: World J Gastroenterol Date: 2015-04-28 Impact factor: 5.742
Authors: L M Best; D J M Haldane; M Keelan; D E Taylor; A B R Thomson; V Loo; C A Fallone; P Lyn; F M Smaill; R Hunt; C Gaudreau; J Kennedy; M Alfa; R Pelletier; S J O Veldhuyzen Van Zanten Journal: Antimicrob Agents Chemother Date: 2003-10 Impact factor: 5.191
Authors: Ju Yup Lee; Nayoung Kim; Min Soo Kim; Yoon Jin Choi; Jung Won Lee; Hyuk Yoon; Cheol Min Shin; Young Soo Park; Dong Ho Lee; Hyun Chae Jung Journal: Dig Dis Sci Date: 2014-03-06 Impact factor: 3.199