Age‐dependent eradication of Helicobacter pylori with dual therapy

Abstract

A causative role is now accepted for Helicobacter pylori for the development of erosive gastritis, duodenal and gastric ulcer. Eradication of the infection results in cure of erosive gastritis and a stable remission of peptic ulcer. During the last few years different treatment regimens have been tried, of which omeprazole and amoxycillin have been the most frequently used because this dual therapy is simple (b.d. dosing for 2 weeks) and welltolerated. However, the eradication rates vary widely (10±80%) and the decisive factors in¯uencing the ef®cacy remain unclear. 1, 2Based on experience with classical triple therapy (bismuth salt + two antibiotics), age might be considered as an important factor. However, although one trial reported an association between H. pylori eradication rate and advanced age, 3 another study could not . Intragastric pH and plasma levels of the administered drugs were monitored over a dosing interval of 12 h. Results: The overall eradication rates were 45% (intention-to-treat, ITT, 27/60) or 47% (per protocol 27/58); they did not differ (ITT) between omeprazole (50%), lansoprazole (40%) and ranitidine (45%).

Amoxicillin/Metronidazole/Omeprazole/Clarithromycin: A New, Short Quadruple Therapy for Helicobacter pylori Eradication

“…Clarithromycin has been shown to be the most effective single agent, but antimicrobial monotherapy increases the risk of inducing bacterial resistance [1]. Dual therapies achieved unsatisfactory results; the mean eradication rates of proton‐pump inhibitors + amoxicillin were about 60% [2–4], with a large variability due to different influences such as age of patients [5], duration of therapy, or pretreatment with proton‐pump inhibitors [4,6]. Bismuth‐based triple therapies containing bismuth salt, imidazoles, and either tetracycline or amoxicillin result in favorable eradication rates (up to 90%), but the frequency of adverse effects is high and regimens are complicated because of multiple daily dosages.…”

Reply — Efficacy of 1‐week ranitidine‐ bismuth‐citrate (RBC)‐based triple therapy for eradication of Helicobacter pylori infection

“…This reduces further the cost of therapy, if the American authors wanted also to address this important aspect. Later, other authors 3,4 con®rmed our excellent results on larger series and nowadays the good performance of this new 1-week RBC-based regimen can be considered consolidated, as con®rmed by a recent paper showing the results of many studies using this therapeutic scheme. 5 By pooling together all these trials, Pipkin et al show that RBC-based triple therapy allows us to achieve high and consistent eradication rates, which are similar to those of proton pump inhibitor-based triple regimens.…”

“…1 However, our intragastric pH-®ndings during treatment with dual therapy were not substantially age-dependent. 4 It is much more likely that signi®cant differences in drug disposition (except for metronidazole) 5 may account for the`age-effect'. Thus, the ideal candidate for short-term quadruple regimens such as CALM seems to be the older non-smoking patient.…”

“…We also observed that age (beside smoking status in our study) is a clinical factor that in¯uences the outcome of treatment: older age ( 55 vs. > 55 years) has an association with a lower incidence of eradication failure: 15% vs. 6%, P 0.03, thus con®rming previous results seen with dual therapy. 4 In both studies we randomized according to age, while others did not.…”

“…3 For example, comparable designed trials of identical regimens with 1-week PPI-based triple therapies revealed that eradication rates in the United States are 10±20% lower than rates achieved in Europe. 4,5 It is especially imperative that shorter duration regimens be evaluated in the United States before they can be wholeheartedly endorsed. This was an open label study and thus has inherent weaknesses compared to a randomized control trial, but this was clearly stated in the paper.…”