An optimized clarithromycin-free 14-day triple therapy for Helicobacter pylori eradication achieves high cure rates in Uruguay

Cristina Dacoll, Jordi Sánchez-Delgado, Henia Balter, Ximena Pazos, María Di Pace, Gabriela Sandoya, Henry Cohen, Xavier Calvet

Research output: Contribution to journalArticleResearchpeer-review

2 Citations (Scopus)

Abstract

© 2017 Elsevier España, S.L.U., AEEH y AEG Background Strong acid inhibition increases cure rates with triple therapy and 14-day are more effective than 7-day treatments. The combination of amoxicillin plus metronidazole at full doses has been shown to overcome metronidazole resistance and to achieve good eradication rates even in patients harboring resistant strains. No previous studies have been reported in Latin-America with this optimized triple-therapy scheme. Aims The aim of the present study was to assess the eradication rate and tolerance of a new first-line treatment regimen associating strong acid inhibition, amoxicillin and metronidazole. Methods Patients from the Clínica de Gastroenterología of the Hospital de Clínicas (Montevideo, Uruguay) were included. Hp status was mainly assessed by at least one of the following: histologyor urea breath test (UBT). A 14-day treatment was prescribed comprising esomeprazole 40 mg twice a day plus amoxicillin 1 g and metronidazole 500 mg, both three times a day. H. pylori cure was assessed by UBT. Results Forty-one patients were enrolled. Mean age was 53.3 ± 13 years and 17.1% of patients were male. Main indications for treatment were: functional dyspepsia (27.5%), gastritis (45%), gastric or duodenal erosions (20%), gastric ulcer (5%) and intestinal metaplasia (2.5%). H. pylori eradication was achieved in 33 of the 37 patients who returned for follow-up. Eradication rates were 80.5% (95% CI: 68.4–92.6) by intention-to-treat (ITT) analysis and 89.2% (95% CI; 79.2–99.2) per protocol (PP). No major side effects were reported; 26 patients (65.8%) complained of mild side effects (nausea, diarrhea and headache). Conclusions Cure rates of this triple therapy including esomeprazole, amoxicillin and metronidazole were 81% per ITT and the treatment was well tolerated. These optimal results with a simple clarithromycin-free triple therapy are better than described for standard triple therapy but there is still room for improvement to reach the desired target of 90% per ITT.
Original languageEnglish
Pages (from-to)447-454
JournalGastroenterologia y Hepatologia
Volume40
Issue number7
DOIs
Publication statusPublished - 1 Aug 2017

Keywords

  • Clarithromycin-free
  • Eradication
  • Helicobacter
  • High doses
  • Latin America
  • Treatment
  • Uruguay

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