Bismuth, lansoprazole, amoxicillin and metronidazole or clarithromycin taken in the character of first-line Helicobacter pylori therapy.
Gut. 2015 Sep 2;
Authors: Zhang W, Chen Q, Liang X, Liu W, Xiao S, Graham DY, Lu H
OBJECTIVE: To evaluate the efficacy and tolerability of replacing tetracycline with amoxicillin in bismuth quadruple therapy.
DESIGN: Subjects who were infected by Helicobacter pylori and naïve to handling were randomly (1:1) assigned to hold a 14-day modified bismuth quadruple therapy: lansoprazole 30 mg, amoxicillin 1 g, bismuth potassium citrate 220 mg (elemental bismuth), two times a day with metronidazole 400 mg four epochs a day (metronidazole group) or clarithromycin 500 mg twice a day (clarithromycin group). Six weeks afterward treatment, H. pylori eradication was assessed ~ the agency of (13)C-urea breath test. Antimicrobial susceptivity was assessed by the twofold agar dilution process. This was a non-inferiority wretchedness.
RESULTS: Two hundred and fifteen subjects were randomised. Metronidazole and clarithromycin containing regimens achieved occult cure rates: 94 of 97 (96.9%, 95% CI 93.5% to 100%) and 93 of 98 (94.9%, 95% CI 90.5% to 99.3%) through per-protocol and 88.9% (95% CI 83.0% to 94.8%) and 88.8% (95% CI 82.8% to 94.8%) ~ means of intention-to-treat, respectively. Amoxicillin, metronidazole and clarithromycin opposition rates were 1.5%, 45.5% and 26.5%, particularly. Only clarithromycin resistance reduced treatment success (eg, susceptible 98.6%, resistant 76.9%, p=0.001). Adverse events were to a greater degree common in the metronidazole group.
CONCLUSIONS: These results recommend that amoxicillin can substitute for tetracycline in modified 14 day bismuth quadruple therapy as first-line treatment and still overcome metronidazole opposition in areas with high prevalence of metronidazole and clarithromycin hindrance. Using clarithromycin instead of metronidazole was solitary effective in the presence of susceptible strains.
TRIAL REGISTRATION NUMBER: NCT02175901.
PMID: 26338726 [PubMed – being of the cl~s who supplied by publisher]
registered trademarks and servicemarks mentioned without interrupti~ this site are the property