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

IF 4.3 2区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Helicobacter Pub Date : 2024-02-08 DOI:10.1111/hel.13052
Christian von Muhlenbrock, Andrea Cordova, Paulina Nuñez, Nicole Pacheco, Karin Herrera, Rodrigo Quera
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Abstract

Introduction

In 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%.

Aim

To evaluate the eradication rate and safety of dual therapy (esomeprazole and amoxicillin) in high doses, through a prospective, observational, and descriptive study.

Methods

Patients 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.

Results

Of 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.

Conclusions

In 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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大剂量阿莫西林和质子泵抑制剂作为幽门螺旋杆菌感染一线治疗的根除率和依从性:智利大学医院的经验。
简介在智利,70%以上的成年人感染幽门螺旋杆菌。如果对克拉霉素的耐药性大于 15%(在我国人群中大于 26%),则任何治疗方案都不应使用该抗生素。在这种情况下,三联疗法(质子泵抑制剂[PPI]、克拉霉素、阿莫西林)的有效率仅为 63.8%。目的:通过一项前瞻性、观察性和描述性研究,评估大剂量双重疗法(埃索美拉唑和阿莫西林)的根除率和安全性:方法:纳入在上消化道内窥镜检查中尿素酶检测呈阳性的患者。方法:纳入上消化道内镜检查中尿素酶检测呈阳性的患者,不包括之前使用过任何其他幽门螺杆菌根除疗法的患者。所有患者均接受埃索美拉唑 40 毫克、一天三次和阿莫西林 750 毫克、一天四次的治疗,共 14 天。在完成根除治疗 6 周后,通过幽门螺杆菌粪便抗原检测(使用的是 Pylori-Strip®检测试剂盒)评估双重疗法的根除率,如果检测结果为阴性,则证明该疗法有效:在122名患者中,106名患者的粪便中幽门螺杆菌抗原呈阴性;根据意向治疗和方案分析,根除率分别为91.8% [95% CI:87%-97%] 和94% [95% CI:90%-98%]。有四名患者因不良反应而中断治疗。吸烟和坚持治疗与根除率有关:在这批幽门螺杆菌感染患者中,大剂量双重疗法的根除率高且依从性好,因此有可能在我国用作一线疗法。对更多患者进行的研究应能证实这些结果。
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来源期刊
Helicobacter
Helicobacter 医学-微生物学
CiteScore
8.40
自引率
9.10%
发文量
76
审稿时长
2 months
期刊介绍: Helicobacter is edited by Professor David Y Graham. The editorial and peer review process is an independent process. Whenever there is a conflict of interest, the editor and editorial board will declare their interests and affiliations. Helicobacter recognises the critical role that has been established for Helicobacter pylori in peptic ulcer, gastric adenocarcinoma, and primary gastric lymphoma. As new helicobacter species are now regularly being discovered, Helicobacter covers the entire range of helicobacter research, increasing communication among the fields of gastroenterology; microbiology; vaccine development; laboratory animal science.
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