High and Frequent Dose of Dexlansoprazole and Amoxicillin Dual Therapy for Helicobacter pylori Infections: A Single Arm Prospective Study

Abstract

Background/Aims: Recently, the eradication rate of Helicobacter pylori (H. pylori) infection has decreased to less than 80% worldwide with the use of clarithromycin-based triple therapy owing to the increased resistance of H. pylori to antibiotics, especially clarithromycin and metronidazole. This prospective study aimed to determine eradication rate of H. pylori following high and frequent doses of extended-release dexlansoprazole and amoxicillin, as a dual therapy in a region with high clarithromycin resistance rate. Methods: A total of 50 treatment-naïve patients with active H. pylori infections, who were confirmed through via rapid urease test or histology and serology between November 2015 and February 2016 at our hospital, were included for analysis. All enrolled patients were treated with 750 mg amoxicillin and 30 mg dexlansoprazole, four times a day for a total duration of 14 days. Treatment success was determined using urea breath test four weeks after treatment completion. Results: Seven out of the 50 patients (29 men and 21 women; mean age, 57 years) dropped out during the study. The total eradication rate was 52% (26/50), and that for those with a compliance rate of over 90% was 68.4% (26/38). H. pylori infections were not successfully eradicated in patients with a compliance rate of less than 90%. Nine patients (18%) reported side effects, such as mild diarrhea and abdominal fullness. No significant factors, such as smoking and alcohol consumption, affected the infection the eradication rate. Conclusions: High and frequent doses of proton pump inhibitor-amoxicillin dual therapy were not effective in eradicating H. pylori infection in a province with high clarithromycin resistance rate. (Korean J Gastroenterol 2017;70:176-180)

High‐dose PPI‐amoxicillin dual therapy with or without bismuth for first‐line Helicobacter pylori therapy: A randomized trial

“…As with early studies, the results have been inconsistent and even regimens using the same therapies have not reliably achieved 90% or greater cure rates. Studies have been done in many countries including Korea, Japan, and the United States, and most report cure rates below 90% . Studies in China have also reported variable cure rates …”

“…Studies have been done in many countries including Korea, Japan, and the United States, and most report cure rates below 90%. 13,[18][19][20][21] Studies in China have also reported variable cure rates. 6,7,22 Amoxicillin, a β-lactam antibiotic, is currently widely used in the treatment of H. pylori infections.…”

Primary and secondary antibiotic resistance of Helicobacter pylori in Korea from 2003 to 2018

“…Globally, amoxicillin's resistance to H pylori antibiotics is not high . Therefore, high‐dose dual therapy using only PPI and amoxicillin has been attempted, and the potential for primary treatment has been suggested . Nishizawa et al demonstrated that the amoxicillin dual therapy appeared to serve as a promising option for empiric third‐line rescue therapy in patients with low pretreatment UBT values and resistance to amoxicillin in H pylori was gradually induced after unsuccessful eradication attempts .…”

Efficacy of dexlansoprazole-based triple therapy for Helicobacter pylori infections

“…19 A similar result of dexlansoprazole-amoxicillin dual therapy was also noted in a Korean study. 20 Nonetheless, dexlansoprazole-based triple therapy had a good eradication rate and a similar success rate compared with rabeprazole-based triple therapy. 21,22 A total of 177 H. pylori infected patients were randomized to receive dexlansoprazole-based triple therapy, or rabeprazole-based triple therapy for 7 days.…”