Predictors of failure of Helicobacter pylori eradication with the standard'Maastricht triple therapy'

Citation
F. Perri et al., Predictors of failure of Helicobacter pylori eradication with the standard'Maastricht triple therapy', ALIM PHARM, 15(7), 2001, pp. 1023-1029
Citations number
28
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Pharmacology,"da verificare
Journal title
ALIMENTARY PHARMACOLOGY & THERAPEUTICS
ISSN journal
0269-2813 → ACNP
Volume
15
Issue
7
Year of publication
2001
Pages
1023 - 1029
Database
ISI
SICI code
0269-2813(200107)15:7<1023:POFOHP>2.0.ZU;2-T
Abstract
Background: Triple therapy with proton pump inhibitor, clarithromycin and a moxicillin has recently been proposed in Maastricht as first-line treatment for H. pylori infection. Aim: To determine predictors of unsuccessful eradication. Methods: Two hundred and forty-eight patients underwent endoscopy with biop sies for rapid urease test, histology and culture with antibiotic susceptib ility tests, and C-13-UBT. All infected patients were given pantoprazole (4 0 mg b.d.), clarithromycin (500 mg b.d.) and amoxicillin (1 g b.d.) for 1 w eek. Eradication was assessed by UBT at 4-6 weeks after therapy. Results: One hundred and sixty-two of 248 patients (65%) were infected. Cul ture was positive in 144 (89%), Prevalence rates of metronidazole, clarithr omycin and amoxicillin resistance were 14, 8 and 3%, respectively. Eradicat ion rates (95% CI) were 63% (54.7-70.6) by intention-to-treat analysis and 67% (59.4-75.4) by per protocol analysis. Drug compliance was excellent and side-effects were mild. Age greater than or equal to 45 years (OR: 2.35, C I: 1.30-4.25), smoking (OR: 1.37, CI 1.01-1.87) and high pre-treatment UBT results (OR: 1.36, CI: 1.08-1.72) were independent predictors of eradicatio n failure. Gender, endoscopic findings, alcohol intake, and clarithromycin and amoxicillin resistance did not predict treatment failure. Conclusion: Despite the low prevalence of primary antibiotic resistance in our geographical area, triple therapy with pantoprazole, amoxicillin and cl arithromycin achieves low eradication rates. Smoking, age and pre-treatment UBT results are predictors of potential eradication failure.