Clarithromycin, amoxycillin and H₂‐receptor antagonist therapy for Helicobacter pylori peptic ulcer disease in Korea

Abstract

Background: Effective anti‐Helicobacter pylori therapies with few side‐effects are needed. We previously showed that the regimen of amoxycillin, clarithromycin and an H2‐receptor antagonist was effective in the United States. The current study tested whether this therapy would also be successful in Korea. Methods: Patients with gastric or duodenal ulcers received amoxycillin (750 mg t.d.s.) plus clarithromycin (500 mg t.d.s.) for 2 weeks and nizatidine 300 mg at bedtime for 6 weeks. Endoscopic examinations were performed before treatment and 4 or more weeks after ending antimicrobial therapy. H. pylori status was confirmed by rapid urease testing and histological examination of gastric antrum and corpus biopsies using the Genta stain. Antibiotic resistance was tested using the E‐test method. Cure was defined as no evidence of H. pylori infection 4 or more weeks after ending therapy. Results: Seventy‐two patients (59 males and 13 females; mean age 46 years), including 35 with duodenal ulcers, 30 with gastric ulcers and seven with both, were studied. H. pylori infection was cured in 95.8% (69/72 patients; 95% CI = 88.3–99.1%). Two of the treatment failures had culture data and one had pre‐treatment resistance to clarithromycin. Smoking did not have an adverse effect on therapy. Ten patients (15%) developed side‐effects during treatment, but all were mild and did not require treatment interruption. No case of reinfection was noted during follow‐up. Conclusion: The combination of amoxycillin, clarithromycin and an H2‐receptor antagonist is effective in Korean patients with H. pylori infection.

Head‐to‐head comparison of 1‐week triple regimens combining ranitidine or omeprazole with two antibiotics to eradicate Helicobacter pylori

“…The low power of this study, however, does not allow us to conclude that ranitidine‐ and omeprazole‐based regimens can be considered equivalent. However, our findings achieved in a trial comparing head‐to‐head proton pump inhibitor‐ and H 2 ‐RA‐based triple therapies reinforces the results reported in previous studies assessing the efficacy of these drug combinations separately or together in small sample trials, 13 –21 and leads us to question the importance of profound acid suppression in the eradication of the bacterium.…”

“…More importantly, doubling the dosage of clarithromycin from 500 to 1000 mg/day decreased the success of the treatment. Furthermore, although clarithromycin is known to be a powerful antibiotic against H. pylori , it has been suggested that clarithromycin resistance may reduce the efficacy of triple regimens combining this drug with an H 2 ‐RA and amoxycillin 20 . This makes it easy to predict a lower than expected success in populations with a high prevalence of background clarithromycin resistance.…”

Potent Gastric Acid Inhibition in Helicobacter pylori Eradication

“…[3] Multiple studies and trials have been published that include the H 2 receptor antagonists as anti-secretory agents, with relatively encouraging results. [4][5][6][7][8][9][10][11][12] The first thing to do is thus to consider whether the PPIs are superior to the anti-H 2 in this indication. On the one hand the PPIs possess, different to the H 2 receptor antagonists, intrinsic antibacterial activity against H. pylori, [13] besides producing a synergic pharmacokinetic interaction with the antibiotics.…”

Strategy for Treatment of Helicobacter pylori Infection in Adults II. Practical Policy in 2000

“…The benefit of PPIs in eradication therapy is mainly due to acid suppression as described above, and H2RAs can be substituted for PPIs and maintain high eradication rates [38,39]. For example, some randomized controlled studies showed the same eradication rates between PPIbased and H2RA-based 1-week triple therapies [65,66].…”

“…The effect of PPIs in combination therapies may be a synergistic effect. Because H2RAs have no antibacterial activities in vitro (Table 1) and also produce high eradication rates (89%-95.8%) in combination therapies, it is as likely that the primary effect is suppression of acid rather than the antimicrobial activity [38,39]. Because bismuth has different antibacterial mechanisms from other antibiotics and resistance has not been reported, it has been used in the combination therapy for H. pylori infection [33].…”