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Sequential, standard triple therapy for H. pylori compared in context of antibiotic resistance
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Antibiotic resistance compromised Helicobacter pylori eradication rates with standard triple therapy and sequential therapy, according to new data which also show that sequential therapy was appropriate in regions with high rates of isolated clarithromycin resistance but ineffective in the presence of clarithromycin and metronidazole resistance.
Chinese researchers studied 338 patients with positive H. pylori cultures at four centers between March 2009 and December 2010. Patients were randomly assigned to two treatment groups:
- Standard triple therapy (STT): 10 days of esomeprazole, amoxicillin and clarithromycin (n=140)
- Sequential therapy (SQT): 5 days of esomeprazole and amoxicillin, followed by 5 days of esomeprazole, clarithromycin, and tinidazole (n=140).
Patients were assessed for eradication 8 to 12 weeks after treatment.
In both an intention-to-treat analysis and per-protocol analysis, eradication rates with STT were 66.4% (95% CI, 59.3-74.3). Eradication rates with SQT were 72.1% (95% CI, 65-79.3; P=.3).
Resistance to clarithromycin (CLA-R; P<.001) and metronidazole (MET-R; P=.013) both were independent predictors of treatment failure in the SQT group.
A lower eradication rate of 43.9% was observed in the SQT group with dual CLA-R and MET-R compared with those having isolated CLA-R (88.9%; P=.024) or isolated MET-R (87%, P<.001).
“Resistance patterns encountered in other areas of the world may already be similar to those in China, or may become similar in the near future,” the study authors wrote. “In regions were there are high rates of CLA-R and MET-R, it is likely that eradication rates achieved with SQT … will continue to become progressively more unsatisfactory. In contrast, in areas with high isolated CLA-R prevalence, SQT regimen remains a relatively good choice.”
Disclosure: Research was supported by the National Science and Technology Pillar Program of 11th Five-Year Plan in China.
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