Clarithromycin-based triple therapy for Helicobacter pylori treatment in peptic ulcer patients

Abstract

Introduction: The scheme proton pump inhibitor/amoxicillin/clarithromycin (PPI/AC) is still the first-line treatment for Helicobacter pylori (H. pylori) infections despite evidence suggesting its failure in up to 20% to 30% of patients. Methodology: This study involved 493 patients who were prescribed omeprazole (20 mg twice a day) or another proton pump inhibitor in equivalent dosage, amoxicillin (1 g twice a day), and clarithromycin (500 mg twice a day) for seven days. Efficacy was determined by negative urease test and absence of H. pylori on gastric biopsy samples twelve weeks after the end of treatment. Safety was defined according to the adverse effects reported. Mean age of the patients was (± SD) 48.96 ± 13, and demographic and clinical data were recorded for correlation with treatment outcomes. Results: Out of 493 patients, 316 (64.1%) presented duodenal ulcer, 111 (22.5%) gastric ulcer, and 66 (14.4%) simultaneous gastric and duodenal ulcers. Additionally, 267 (54.2%) patients had at least one risk factor for peptic ulcer disease, smoking being the most common (99 [36.5%]). Successful eradication was achieved in 408 patients. The eradication rates per protocol, and according to the intention to treat, were 88.8% and 82.7%, respectively. Of 164 (35.5%) patients who presented adverse effects, 100 (61%) reported them as mild and only six (3.7%) patients had to discontinue treatment. Previous use of tobacco and non-steroid anti-inflammatory drugs was the only risk factor for treatment failure (P 0.00). Conclusion: PPI/AC is still a valuable and remarkably tolerable option for first-line H. pylori eradication in Brazil.

Tratamiento ideal del Helicobacter pylori: una revisión sistemática

“…Sin embargo, en otros países, como Brasil y Reino Unido, las tasas de erradicación fueron superiores 19,51 , siendo estos resultados similares a los obtenidos en países con bajas tasas de resistencia a claritromicina (menor del 15 al 20%). Adicionalmente, con terapias mayores a 7 días de duración no se encontró mayor eficacia de erradicación, como en los casos de Estados Unidos, Colombia y Chile 24,41,42 .…”

3rd BRAZILIAN CONSENSUS ON Helicobacter pylori

“…The few Brazilian studies on clarithromycin resistance show rates below this value (45,78,123,160) . While not outstanding, in the last 10 years this regimen has shown eradication rates close to 80% among us (29,54,134,166) . Such results have also recently been described by a Spanish group while treating H pylori infection over 12 years (77) .…”

“…H pylori should be eradicated and searched in GERD patients who require chronic use of proton pump inhibitors (142,178,209) . The triple therapy is still the most used and recommended worldwide and also in Brazil (4,13,29,31,54,68,124,134,166,207) . Its effectiveness basically depends on rates of resistance to clarithromycin and is not recommended in areas where these rates among the population are higher than 20%.…”

Clinical Management of <b><i>Helicobacter pylori</i></b>: The Latin American Perspective

“…Although not excellent, in the last 10 years, this regimen has shown eradication rates greater than 80% in Argentina [36], Brazil [37,38,39], Colombia [40] and Peru [41,42]. A recent randomized trial involving 7 Latin American countries, including Chile and Colombia, obtained 82.2% eradication of H. pylori with the triple classic scheme during 14 days, this regimen being preferable to 5-day concomitant or 10-day sequential 4-drug regimens [43].…”