BACKGROUND: Studies with CYP2C19 slow metabolizers have shown that the combination of a proton pump inhibitor (PPI) plus amoxicillin (dual therapy) can reliably cure more than 90% of Helicobacter pylori infections. Theoretically, the use of a PPI dose that provides equivalent acid suppression with fast metabolizers and slow metabolizers would achieve high cure rates irrespective of the CYP2C19 genotype. AIM: To evaluate high-dose PPI plus amoxicillin dual therapy for H. pylori eradication. METHODS: H. pylori-infected individuals (positive by 2 tests) received esomeprazole 40 mg plus amoxicillin 750 mg every 8 h for 14 days. The protocol was planned based on the "efficient identification strategy" requiring more than 90% success, with stop criteria of 6 or more failures within 50 patients or a cure rate of less than 80%. RESULTS: Thirty-six patients (5 women, 31 men), average age 58 years, were enrolled before achieving stop criteria. All were first H. pylori treatments. The intention-to-treat cure was achieved in 26/36 [72.2%; 95% confidence interval (CI) = 56-84%] and in 26/35 per protocol (74.2%; 95% CI = 56-87%). There were no significant side effects. Compliance was 85% or greater in all (100% in 91.6%). CONCLUSIONS: If the hypothesis that consistently high intragastric pH is required to reliably achieve more than 90% H. pylori eradication, our regimen was not sufficient. Success may require more than every 8 h dosing, the concomitant administration of sodium bicarbonate, or the use of a long-acting PPI. However, the result was positive in that dual therapy with the doses tested here was at least as successful as empiric triple therapy.
BACKGROUND: Studies with CYP2C19 slow metabolizers have shown that the combination of a proton pump inhibitor (PPI) plus amoxicillin (dual therapy) can reliably cure more than 90% of Helicobacter pylori infections. Theoretically, the use of a PPI dose that provides equivalent acid suppression with fast metabolizers and slow metabolizers would achieve high cure rates irrespective of the CYP2C19 genotype. AIM: To evaluate high-dose PPI plus amoxicillin dual therapy for H. pylori eradication. METHODS: H. pylori-infected individuals (positive by 2 tests) received esomeprazole 40 mg plus amoxicillin 750 mg every 8 h for 14 days. The protocol was planned based on the "efficient identification strategy" requiring more than 90% success, with stop criteria of 6 or more failures within 50 patients or a cure rate of less than 80%. RESULTS: Thirty-six patients (5 women, 31 men), average age 58 years, were enrolled before achieving stop criteria. All were first H. pylori treatments. The intention-to-treat cure was achieved in 26/36 [72.2%; 95% confidence interval (CI) = 56-84%] and in 26/35 per protocol (74.2%; 95% CI = 56-87%). There were no significant side effects. Compliance was 85% or greater in all (100% in 91.6%). CONCLUSIONS: If the hypothesis that consistently high intragastric pH is required to reliably achieve more than 90% H. pylori eradication, our regimen was not sufficient. Success may require more than every 8 h dosing, the concomitant administration of sodium bicarbonate, or the use of a long-acting PPI. However, the result was positive in that dual therapy with the doses tested here was at least as successful as empiric triple therapy.
Authors: T Furuta; K Ohashi; K Kosuge; X J Zhao; M Takashima; M Kimura; M Nishimoto; H Hanai; E Kaneko; T Ishizaki Journal: Clin Pharmacol Ther Date: 1999-05 Impact factor: 6.875
Authors: S D Georgopoulos; S D Ladas; S Karatapanis; K Triantafyllou; C Spiliadi; A Mentis; V Artikis; S A Raptis Journal: Aliment Pharmacol Ther Date: 2002-03 Impact factor: 8.171
Authors: E Bayerdörffer; S Miehlke; G A Mannes; A Sommer; W Höchter; J Weingart; W Heldwein; H Klann; T Simon; W Schmitt Journal: Gastroenterology Date: 1995-05 Impact factor: 22.682
Authors: K S Graham; H Malaty; H M el-Zimaity; R M Genta; R A Cole; M T al-Assi; M M Yousfi; G A Neil; D Y Graham Journal: Am J Gastroenterol Date: 1995-09 Impact factor: 10.864
Authors: Kristina G Hulten; Robert M Genta; Ira N Kalfus; Yi Zhou; Hongjun Zhang; David Y Graham Journal: Gastroenterology Date: 2021-07-19 Impact factor: 33.883