Ping-I Hsu1, Deng-Chyang Wu, Jeng-Yih Wu, David Y Graham. 1. Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Veterans General Hospital and National Yang-Ming University, Kaohsiung, Taiwan. williamhsup@yahoo.com.tw
Abstract
BACKGROUND: Ten-day sequential therapy with a proton pump inhibitor (PPI) and amoxicillin followed by a PPI, clarithromycin, and an imidazole typically achieves Helicobacter pylori eradication rates of 90-94% (Grade B success). AIMS: We tested whether prolonging treatment and continuing amoxicillin throughout the 14-day treatment period would produce a ≥ 95% result. METHODS: This was a multicenter pilot study in which H. pylori-infected patients received a 14-day sequential-concomitant hybrid therapy (esomeprazole and amoxicillin for 7 days followed by esomeprazole, amoxicillin clarithromycin, and metronidazole for 7 days). H. pylori status was examined 8 weeks after therapy. Success was defined as achieving ≥ 95% eradication by per-protocol analysis. RESULTS:One hundred and seventeen subjects receivedhybrid therapy. The eradication rate was 99.1% (95% confidence interval (CI), 97.3-100.0%) by per-protocol analysis and 97.4% by intention-to-treat analysis (95% CI, 94.5-100.0%). Adverse events were seen in 14.5%; drug compliance was 94.9%. CONCLUSIONS: Fourteen-day hybrid sequential-concomitant therapy achieved > 95%H. pylori eradication (Grade A result). Further studies are needed 1, in regions with different patterns and frequencies of resistance to confirm these findings, and 2, to examine whether Grade A success is maintained with hybrid therapy shorter than 14 days.
RCT Entities:
BACKGROUND: Ten-day sequential therapy with a proton pump inhibitor (PPI) and amoxicillin followed by a PPI, clarithromycin, and an imidazole typically achieves Helicobacter pylori eradication rates of 90-94% (Grade B success). AIMS: We tested whether prolonging treatment and continuing amoxicillin throughout the 14-day treatment period would produce a ≥ 95% result. METHODS: This was a multicenter pilot study in which H. pylori-infectedpatients received a 14-day sequential-concomitant hybrid therapy (esomeprazole and amoxicillin for 7 days followed by esomeprazole, amoxicillin clarithromycin, and metronidazole for 7 days). H. pylori status was examined 8 weeks after therapy. Success was defined as achieving ≥ 95% eradication by per-protocol analysis. RESULTS: One hundred and seventeen subjects received hybrid therapy. The eradication rate was 99.1% (95% confidence interval (CI), 97.3-100.0%) by per-protocol analysis and 97.4% by intention-to-treat analysis (95% CI, 94.5-100.0%). Adverse events were seen in 14.5%; drug compliance was 94.9%. CONCLUSIONS: Fourteen-day hybrid sequential-concomitant therapy achieved > 95%H. pylori eradication (Grade A result). Further studies are needed 1, in regions with different patterns and frequencies of resistance to confirm these findings, and 2, to examine whether Grade A success is maintained with hybrid therapy shorter than 14 days.
Authors: P Malfertheiner; F Megraud; C O'Morain; F Bazzoli; E El-Omar; D Graham; R Hunt; T Rokkas; N Vakil; E J Kuipers Journal: Gut Date: 2006-12-14 Impact factor: 23.059
Authors: P I Hsu; K H Lai; H H Tseng; Y C Liu; M Y Yen; C K Lin; G H Lo; R L Huang; J S Huang; J S Cheng; W K Huang; L P Ger; W Chen; P N Hsu Journal: J Clin Gastroenterol Date: 1997-12 Impact factor: 3.062
Authors: Ping I Hsu; Il-Ran Hwang; Diana Cittelly; Kwok-Hung Lai; Hala M T El-Zimaity; Oscar Gutierrez; Jong G Kim; Michael S Osato; David Y Graham; Yoshio Yamaoka Journal: Am J Gastroenterol Date: 2002-09 Impact factor: 10.864
Authors: P I Hsu; K H Lai; C J Wu; H H Tseng; F W Tsay; N J Peng; T A Chen; S K Chuah; W S Lin; G H Lo Journal: Eur J Clin Invest Date: 2007-09 Impact factor: 4.686