Clinical Evaluation of a Ten‐Day Regimen with Esomeprazole, Metronidazole, Amoxicillin, and Clarithromycin for the Eradication of Helicobacter pylori in a High Clarithromycin Resistance Area

Abstract

The 10-days "concomitant" regimen is effective and safe first-line H. pylori treatment, in a high clarithromycin resistance area, although dual antibiotic resistance may compromise its effectiveness.

Antimicrobial resistance of Helicobacter pylori strains to five antibiotics, including levofloxacin, in Northwestern Turkey

“…In contrast, in the present study, which was performed in Istanbul, no tetracycline resistance was detected. We detected no amoxicillin or tetracycline resistance in our study, and our results are in accord with those of Georgopoulos et al (17) and Boyanova et al (18) for amoxicillin resistance.…”

“…Our result is higher than the results of Georgopoulos et al (17) (16%) and Boyanova et al (18) (10%) for levofl oxacin resistance rates. This difference could be due to the crowded population, to the geographic location of Istanbul or to the frequent use of this antibiotic for respiratory and/or urinary infections in this area.…”

“…For example, among countries neighboring Northwestern Turkey, the clarithromycin and metronidazole resistance rates in untreated patients in Greece were reported to be 31% and 43%, respectively, by Georgopoulos et al (17) ; in Bulgaria, the corresponding rates were and 20.8% and 31.2%, as reported by Boyanova et al (18) ( (19) . According to this multicenter study, the H. pylori resistance rates to clarithromycin and levofl oxacin were signifi cantly higher in Western/central and Southern Europe (>20%) than in Northern European countries (<10%) (19) .…”

“…Wueppenhorstet al (20) and Larsen et al (21) in Norway reported H. pylori amoxicillin and tetracycline resistance rates of 1.4% and 0% in Germany and 10% and 0% in Norway, respectively. Cuadrado-Lavínet al (27) in Spain and Georgopoulos et al (17) in Greece reported no amoxicillin resistance. Boyanova et al (18) reported 2% tetracycline resistance.…”

Helicobacter pylori: Effect of coexisting diseases and update on treatment regimens

“…Two novel eradication regimens, namely concomitant and hybrid therapy, have proven more effective than triple and sequential therapy in the last few years, particularly in patients with dual-(clarithromycin-and metronidazole-) resistant H. pylori strains [107][108][109][110][111] . Metaanalyses have shown that the outcome of concomitant therapy is duration-dependent [112] .…”