Quadruple therapies are superior to standard triple therapy for Helicobacter pylori first-line eradication in Chile

Reyes, Diego; Ortíz, Javier; Fuentes‐López, Eduardo; Budnik, Sigall; Gandara, Vicente; Gallardo, Andrea; Seydewitz, María Francisca; Cândia, Roberto; Vargas, José Ignacio; Rollán, María Paz; Godoy, Javiera; Rollán, Antonio; Mansilla, Ricardo; Arenas, Alex; Chahuán, Javier; Espino, Alberto; Pizarro, Margarita; Riquelme, Arnoldo

doi:10.1016/j.gastre.2022.07.004

Cited by 1 publication

(6 citation statements)

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“…However, only 35 patients (14.5% of the patients included in this study) received this treatment regimen. 7 The high eradication success rate of HDDT in our study could be attributed to the following factors 1 : in Chile, the rate of resistance to amoxicillin is 4.2%, lower than clarithromycin resistance. 21 In the Eastern Mediterranean and Americas Region, the prevalence of primary amoxicillin resistance was relatively high, accounting for approximately 14% and 10% respectively, 22 this could reduce the efficacy of this therapy in the eradication of H. pylori 2 ; higher dosing frequency of the PPI dose (three times daily) has been associated with longer lasting anti-acidic effects.…”

Section: Discussionmentioning

confidence: 58%

“…17 It is still important, due to a more local reality, that two studies carried out in Latin America have also confirmed the effectiveness of this regimen. 7,20 A previous Chilean study suggests that HDDT, with an effectiveness of 88.6%, could be considered as a first-line regimen for H. pylori eradication.…”

Section: Discussionmentioning

confidence: 99%

“…A meta‐analysis of six studies involving 1677 H. pylori ‐infected patients, demonstrated that HDDT is as effective as the bismuth‐containing quadruple regimen (intention‐to‐treat: 84.6% vs. 83.7%, relative risk (RR) = 1.01, 95% CI: 0.97–1.06, p = 0.49; per protocol: 88.4% vs. 89.0%, RR = 1.00, 95% CI: 0.97–1.04, p = 0.99) 17 . It is still important, due to a more local reality, that two studies carried out in Latin America have also confirmed the effectiveness of this regimen 7,20 . A previous Chilean study suggests that HDDT, with an effectiveness of 88.6%, could be considered as a first‐line regimen for H. pylori eradication.…”

Section: Discussionmentioning

confidence: 99%

“…6 However, a study conducted in Chile, involving 242 patients, revealed that 54.9% of them received this treatment despite the challenges mentioned. 7 Furthermore, in Chile, The Ministry of Health has still maintained free eradication of H. pylori for patients with standard tritherapy (amoxicillin, clarithromycin and omeprazole) for 14 days. 8 The consensus guidelines have suggested as a first-line treatment either a quadruple concomitant regimen without bismuth (PPI, clarithromycin, amoxicillin, and metronidazole) or a quadruple combination with bismuth (PPI, bismuth, tetracycline, and metronidazole).…”

Section: Introductionmentioning

confidence: 99%

“…In this scenario, the effectiveness of triple therapy (proton pump inhibitor (PPI), clarithromycin, amoxicillin) was only 63.8% 6 . However, a study conducted in Chile, involving 242 patients, revealed that 54.9% of them received this treatment despite the challenges mentioned 7 . Furthermore, in Chile, The Ministry of Health has still maintained free eradication of H .…”

Section: Introductionmentioning

confidence: 99%

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Eradication rate and adherence with high‐dose amoxicillin and proton pump inhibitor as first‐line treatment for Helicobacter pylori infection: Experience from University Hospital in Chile

von Muhlenbrock,

Cordova,

Nuñez

et al. 2024

Helicobacter

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IntroductionIn Chile, more than 70% of adults are infected by Helicobacter pylori. Clarithromycin should not be used in any regimen if there is >15% resistance to this antibiotic, being greater than 26% in our population. In this scenario, the effectiveness of triple therapy (proton pump inhibitor [PPI], clarithromycin, amoxicillin) was only 63.8%.AimTo evaluate the eradication rate and safety of dual therapy (esomeprazole and amoxicillin) in high doses, through a prospective, observational, and descriptive study.MethodsPatients with a positive urease test obtained in an upper digestive endoscopy were included. Any other previous H. pylori eradication regimen were excluded. All patients were treated with esomeprazole 40 mg three times a day and amoxicillin 750 mg four times a day for 14 days. The eradication rate of the dual therapy was evaluated with the H. pylori stool antigen test (the Pylori‐Strip® test used) 6 weeks after completing the eradication treatment and with at least 14 days without PPI, being a negative result, confirmation of the effectiveness of this regimen.ResultsOf 122 patients, 106 had a negative H. pylori antigen in stool; The intention‐to‐treat and per protocol analysis, the eradication rates were 91.8% [95% CI: 87%–97%] and 94% [95% CI: 90%–98%], respectively. Four patients discontinued treatment due to adverse effects. Smoking and adherence to treatment were associated with eradication rate.ConclusionsIn this cohort of patients with H. pylori infection, high‐dose dual therapy has a high eradication rate and good adherence, raising the possibility that it could be used as first‐line therapy in our country. Studies with a larger number of patients should confirm these results.

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Section: Discussionmentioning

confidence: 58%

Section: Discussionmentioning

confidence: 99%