Vincenzo De Francesco1, Lorenzo Ridola2, Cesare Hassan3, Annamaria Bellesia4, Domenico Alvaro2, Dino Vaira5, Angelo Zullo3. 1. Gastroenterology Unit, Riuniti Hospital, Foggia, Italy. vdefrancesco@ospedaliriunitifoggia.it. 2. Gastroenterology Unit, Sapienza University of Rome, Polo Pontino, Latina, Italy. 3. Gastroenterology and Digestive Endoscopy, Nuovo Regina Margherita Hospital, Rome, Italy. 4. Gastroenterology Unit, Riuniti Hospital, Foggia, Italy. 5. Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
Abstract
BACKGROUND AND AIMS: The updated Italian guidelines advise a standard 14-day triple therapy for first-line H. pylori eradication. This prospective study evaluated the cure rate following a 14-day triple therapy with either a standard or double-dose proton pump inhibitor (PPI). METHODS: A total of 145 consecutive patients with H. pylori infection were randomized to receive a 14-day, first-line triple therapy with clarithromycin 500 mg, amoxicillin 1 g and esomeprazole at either 20 mg (standard therapy) or 40 mg (double-dose therapy), each given twice daily. RESULTS: At intention-to-treat analysis, H. pylori infection was cured in 73.9% (95% CI: 63.9-84) and 81.9% (95% CI: 73-90.8) following standard and double-dose therapy, respectively, and in 78.2% (95% CI: 68.5-87.9) and 85.5% (95% CI: 77.2-93.8) at per-protocol analysis. No statistically significant difference occurred. Overall, 16.4% and 19.4% patients in the standard and double-dose therapy regimen complained of side effects. CONCLUSION: The success rate of both standard and double-dose 14-day triple therapies for first-line H. pylori treatment was unsatisfactory. A prolonged 14-day levofloxacin-based triple therapy for second-line H. pylori eradication seems to be promising.
RCT Entities:
BACKGROUND AND AIMS: The updated Italian guidelines advise a standard 14-day triple therapy for first-line H. pylori eradication. This prospective study evaluated the cure rate following a 14-day triple therapy with either a standard or double-dose proton pump inhibitor (PPI). METHODS: A total of 145 consecutive patients with H. pyloriinfection were randomized to receive a 14-day, first-line triple therapy with clarithromycin 500 mg, amoxicillin 1 g and esomeprazole at either 20 mg (standard therapy) or 40 mg (double-dose therapy), each given twice daily. RESULTS: At intention-to-treat analysis, H. pyloriinfection was cured in 73.9% (95% CI: 63.9-84) and 81.9% (95% CI: 73-90.8) following standard and double-dose therapy, respectively, and in 78.2% (95% CI: 68.5-87.9) and 85.5% (95% CI: 77.2-93.8) at per-protocol analysis. No statistically significant difference occurred. Overall, 16.4% and 19.4% patients in the standard and double-dose therapy regimen complained of side effects. CONCLUSION: The success rate of both standard and double-dose 14-day triple therapies for first-line H. pylori treatment was unsatisfactory. A prolonged 14-day levofloxacin-based triple therapy for second-line H. pylori eradication seems to be promising.
Authors: Enzo Ierardi; Giuseppe Losurdo; Rosa Federica La Fortezza; Mariabeatrice Principi; Michele Barone; Alfredo Di Leo Journal: World J Gastroenterol Date: 2019-09-14 Impact factor: 5.742