Efficacy of 14-day concomitant quadruple therapy and 14-day high-dose dual therapy on H. pylori eradication
Gastroenterology and Hepatology from Bed to Bench,
Vol. 15 No. 2 (2022),
15 March 2022
https://doi.org/10.22037/ghfbb.vi.2412
Abstract
Aim: We compared the efficacy of two different regimens for H. pylori eradication in areas with high antibiotic resistance.
Background: Helicobacter pylori (H. pylori) is a gram-negative bacillus that has a strong association with chronic gastritis and peptic ulcer disease. Different regimens with varying degrees of effectiveness have been used for H. pylori eradication.
Methods: The current randomized controlled trial (RCT) randomly assigned 217 patients who had indications for H. pylori eradication therapy to two groups. One group were administered concomitant quadruple therapy (pantoprazole 40 mg, amoxicillin 1 gr, clarithromycin 500 mg, and metronidazole 500 mg every 12 hours) for 14 days, and the second group received 14 days of high-dose dual therapy, consisting of esomeprazole 40 mg BID and amoxicillin 1g TDS. H. pylori eradication was assessed eight weeks after the end of treatment.
Results H. pylori eradication rates by PP analysis for 14 days concomitant quadruple therapy and high-dose dual therapy were 88.6% (95% CI, 80.3−92.8) and 82.2% (95% CI, 74.8–89.5), respectively (p = 0.19). According to intention-to-treat (ITT) analysis, the eradication rates were 81.6% (95% CI, 74.5−88.6) and 80.6% (95% CI, 73–88.1), respectively (p = 0.58). Overall drug side effects were 20.8% in high-dose dual therapy and 49.6% in concomitant quadruple therapy (p < 0.001).
Conclusion: Fourteen days concomitant quadruple therapy can be considered as a relatively acceptable regimen for H. pylori eradication in areas with high clarithromycin and metronidazole resistance. It seems that high-dose dual therapy could be a promising alternative regimen in these areas.
- H. pylori
- High-Dose Dual Therapy
- Concomitant Quadruple Therapy
- Eradication
How to Cite
References
Go MF. Review article: natural history and epidemiology of Helicobacter pylori infection. Aliment Pharmacol Ther 2002;16:S3-15.
Ford AC, Delaney B, Forman D, Moayyedi P. Eradication therapy for peptic ulcer disease in Helicobacter pylori positive patients. Cochrane Database Syst Rev 2006;2:CD003840.
Gisbert J, Calvet X. non‐bismuth quadruple (concomitant) therapy for eradication of Helicobater pylori. Aliment Pharmacol Ther 2011;34:604-17.
Gisbert JP, Calvet X, O'Connor A, Mégraud F, O'Morain CA. Sequential therapy for Helicobacter pylori eradication: a critical review. J Clin Gastroenterol 2010;44:313-25.
Vakil N. H. pylori treatment: new wine in old bottles? Am J Gastroenterol 2009;104:26-30.
Howden CW, Hunt RH. Guidelines for the management of Helicobacter pylori infection. Am J Gastroenterol 1998;93:2330-8.
Malfertheiner P, Megraud F, O’Morain C, Bazzoli F, El-Omar E, Graham D, et al. Current concepts in the management of Helicobacter pylori infection: the Maastricht III Consensus Report. Gut 2007;56:772-81.
Selgrad M, Bornschein J, Malfertheiner P. Guidelines for treatment of Helicobacter pylori in the East and West. Expert Rev Anti-Infect Ther 2011;9:581-8.
Malfertheiner P, Megraud F, O'morain C, Gisbert J, Kuipers E, Axon A, et al. Management of Helicobacter pylori infection—the Maastricht V/Florence consensus report. Gut 2017;66:6-30.
Fakheri H, Firoozi MS, Bari Z. Eradication of Helicobacter pylori in Iran: a review. Middle East J Dig Dis 2018;10:5.
Khademi F, Poursina F, Hosseini E, Akbari M, Safaei HG. Helicobacter pylori in Iran: A systematic review on the antibiotic resistance. Iran J Basic Med Sci 2015;18:2.
Zullo A, Scaccianoce G, De Francesco V, Ruggiero V, D’Ambrosio P, Castorani L, et al. Concomitant, sequential, and hybrid therapy for H. pylori eradication: a pilot study. Clin Res Hepatol Gastroenterol 2013;37:647-50.
Molina–Infante J, Romano M, Fernandez–Bermejo M, Federico A, Gravina AG, Pozzati L, et al. Optimized nonbismuth quadruple therapies cure most patients with Helicobacter pylori infection in populations with high rates of antibiotic resistance. Gastroenterology 2013;145:121-8. e1.
Park SM, Kim JS, Kim BW, Ji JS, Choi H. Randomized clinical trial comparing 10‐or 14‐day sequential therapy and 10‐or 14‐day concomitant therapy for the first line empirical treatment of Helicobacter pylori infection. J Gastroenterol Hepatol 2017;32:589-94.
De Francesco V, Hassan C, Ridola L, Giorgio F, Ierardi E, Zullo A. Sequential, concomitant and hybrid first-line therapies for Helicobacter pylori eradication: a prospective randomized study. J Med Microbiol 2014;63:748-52.
Choe JW, Jung SW, Kim SY, Hyun JJ, Jung YK, Koo JS, et al. Comparative study of Helicobacter pylori eradication rates of concomitant therapy vs modified quadruple therapy comprising proton‐pump inhibitor, bismuth, amoxicillin, and metronidazole in Korea. Helicobacter 2018;23:e12466.
Alhooei S, Fakheri HT, Hosseini V, Maleki I, Taghvaei T, Valizadeh SM, et al. A Comparison between Hybrid and Concomitant Regimens for Helicobacter Pylori Eradication: A Randomized Clinical Trial. Middle East J Dig Dis 2016;8:219.
Bari Z, Fakheri H, Taghvaei T, Yaghoobi M. A Comparison between 10-day and 12-day Concomitant Regimens for Helicobacter Pylori Eradication: A Randomized Clinical Trial. Middle East J Dig Dis 2020;12:106.
Yao C-C, Kuo C-M, Hsu C-N, Yang S-C, Wu C-K, Tai W-C, et al. First-line Helicobacter pylori eradication rates are significantly lower in patients with than those without type 2 diabetes mellitus. Infect Drug Resist 2019;12:1425.
Zullo A, Ridola L, De Francesco V, Gatta L, Hassan C, Alvaro D, et al. High-dose esomeprazole and amoxicillin dual therapy for first-line Helicobacter pylori eradication: a proof of concept study. Ann Gastroenterol 2015;28:448.
Yang X, Wang J-X, Han S-X, Gao C-P. High dose dual therapy versus bismuth quadruple therapy for Helicobacter pylori eradication treatment: a systematic review and meta-analysis. Medicine 2019;98.
Yang J, Zhang Y, Fan L, Zhu Y-J, Wang T-Y, Wang X-W, et al. Eradication efficacy of modified dual therapy compared with bismuth-containing quadruple therapy as a first-line treatment of Helicobacter pylori. Am J Gastroenterol 2019;114:437-45.
Kwack W, Lim Y, Lim C, Graham DY. High dose ilaprazole/amoxicillin as first-line regimen for Helicobacter pylori infection in Korea. Gastroenterol Res Pract 2016;2016.
Yang J-C, Lin C-J, Wang H-L, Chen J-D, Kao JY, Shun C-T, et al. High-dose dual therapy is superior to standard first-line or rescue therapy for Helicobacter pylori infection. Clin Gastroenterol Hepatol 2015;13:895-905. e5.
Yu L, Luo L, Long X, Liang X, Ji Y, Graham DY, et al. High‐dose PPI‐amoxicillin dual therapy with or without bismuth for first‐line Helicobacter pylori therapy: A randomized trial. Helicobacter 2019;24:e12596.
Farzi N, Yadegar A, Sadeghi A, Asadzadeh Aghdaei H, Marian Smith S, Raymond J, et al. High prevalence of antibiotic resistance in Iranian Helicobacter pylori isolates: importance of functional and mutational analysis of resistance genes and virulence genotyping. J Clin Med 2019;8:2004.
Hu J-L, Yang J, Zhou Y-B, Li P, Han R, Fang D-C. Optimized high-dose amoxicillin–proton-pump inhibitor dual therapies fail to achieve high cure rates in China. Saudi J Gastroenterol 2017;23:275.
Zhang Y, Zhu Y-J, Zhao Z, Zhao J-T, Wang T-Y, Yang J, et al. Efficacy of modified esomeprazole-amoxicillin dual therapies for Helicobacter pylori infection: an open-label, randomized trial. European J Gastroenterol Hepatol 2020;32:563-8.
Anagnostopoulos GK, Tsiakos S, Margantinis G, Kostopoulos P, Arvanitidis D. Esomeprazole versus omeprazole for the eradication of Helicobacter pylori infection: results of a randomized controlled study. J Clin Gastroenterol 2004;38:503-6.
Yuan Y, Ford AC, Khan KJ, Gisbert JP, Forman D, Leontiadis GI, et al. Optimum duration of regimens for Helicobacter pylori eradication. Cochrane Database Syst Rev 2013;12:CD008337.
Ierardi E, Losurdo G, La Fortezza RF, Principi M, Barone M, Di Leo A. Optimizing proton pump inhibitors in Helicobacter pylori treatment: Old and new tricks to improve effectiveness. World J Gastroenterol 2019;25:5097.
Graham DY, Javed SU, Keihanian S, Abudayyeh S, Opekun AR. Dual proton pump inhibitor plus amoxicillin as an empiric anti- H.pylori therapy: studies from the United States. J Gastroenterol 2010;45:816-20.
Ren L, Lu H, Li HY, Zhu LY, Xu XQ, Gu LY, et al. New dual therapy for primary treatment of Helicobacter pylori infection: a prospective randomized study in Shanghai, China. J Dig Dis 2014;15:622-7.
Kim SY, Jung SW, Kim JH, Koo JS, Yim HJ, Park JJ, et al. Effectiveness of three times daily lansoprazole/amoxicillin dual therapy for Helicobacter pylori infection in Korea. Br J Clin Pharmacol 2012;73:140-3.
Sugimoto M, Shirai N, Nishino M, Kodaira C, Uotani T, Yamade M, et al. Rabeprazole 10 mg qds decreases 24‐h intragastric acidity significantly more than rabeprazole 20 mg bd or 40 mg om, overcoming CYP 2 C 19 genotype. Aliment Pharmacol Ther 2012;36:627-34.
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