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
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von Muhlenbrock, Christian
Cordova, Andrea
Nuñez, Paulina
Pacheco, Nicole
Herrera, Karin
Quera, Rodrigo
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<p>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.</p>
Keywords
Adult, Amoxicillin, Anti-Bacterial Agents, Chile, Clarithromycin/therapeutic use, Drug Therapy, Combination/adverse effects, Esomeprazole/therapeutic use, Helicobacter Infections/drug therapy, Helicobacter pylori, Hospitals, Humans, Prospective Studies, Proton Pump Inhibitors, Treatment Outcome, SDG 3 - Good Health and Well-being