Comparative Study of Clarithromycin- versus Metronidazole-Based Triple Therapy as First-Line Eradication for <b><i>Helicobacter pylori</i></b>

Abstract

Introduction: Clarithromycin (CAM)-based triple therapy comprising proton pump inhibitors and amoxicillin is administered as first-line eradication treatment against Helicobacter pylori infection. However, the eradication rate achieved with CAM-based triple therapy has decreased to <80% owing to the emergence of CAM-resistant strains. This prospective randomized study aimed to compare the efficacy of CAM-based and metronidazole (MNZ)-based triple therapy in terms of H. pylori eradication. Methods:H. pylori-positive patients were treated with CAM-based triple therapy comprising esomeprazole and amoxicillin (EAC group) or with MNZ-based triple therapy comprising esomeprazole and amoxicillin (EAM group). Results:H. pylori eradication rates achieved in the intention-to-treat (ITT) and per protocol (PP) analyses were 70.6 and 72.7%, respectively, in the EAC group. Eradication rates obtained via ITT and PP analyses were 91.7 and 94.3%, respectively, in the EAM group. In the EAC group, eradication rates were significantly lower in patients harboring CAM-resistant strains than in those harboring CAM-sensitive strains. In contrast, eradication rates were comparable between patients harboring CAM-resistant strains and those harboring CAM-sensitive strains in the EAM group. Conclusion: MNZ-based triple therapy consisting of esomeprazole and amoxicillin is superior to CAM-based triple therapy containing esomeprazole and amoxicillin as first-line eradication treatment against H. pylori.

Systematic review with meta‐analysis: Vonoprazan, a potent acid blocker, is superior to proton‐pump inhibitors for eradication of clarithromycin‐resistant strains of Helicobacter pylori

“…17 Nonrandomized controlled trails and randomized controlled trials have been conducted to evaluate the efficacy of vonoprazan for H. pylori eradication, [17][18][19][20] and meta-analyses of these studies show superior efficacy of vonoprazan-based H. pylori eradication regimens as compared to conventional PPIbased triple therapy regimens. 21,22 As clarithromycin resistance significantly affects the efficacy of eradication therapy, 17,23 clarithromycin resistance is a potential confounding factor in these studies, especially in the retrospective analyses. However, in Jung's meta-analysis, 21 there was no subgroup study based on clarithromycin resistance.…”

Treatment of Helicobacter pylori infection in 2018

“…Based on this, Syria likely represents an area of high resistance. Metronidazole‐based triple therapy has demonstrated efficacy in areas of high clarithromycin resistance (eradication rate with metronidazole 94.3% vs clarithromycin 72.7%) …”

“…Metronidazole-based triple therapy has demonstrated efficacy in areas of high clarithromycin resistance (eradication rate with metronidazole 94.3% vs clarithromycin 72.7%). 22 Quadruple therapy, comprised of standard triple therapy with the addition of rifaximin (a nonabsorbable antibiotic), had poor results with eradication rates of 61% in Spain. 23 Metronidazole continues to underperform in triple therapy, with eradication rates of 64% in metronidazole-naive patients.…”

Preparation and biological evaluation of metronidazole derivatives with monoterpenes and eugenol

“…It is considered by far the drug of choice for anaerobic infections . The use of metronidazole in diverse therapeutic regimens for the treatment of gastric ulcer caused by the facultative anaerobe Helicobacter pylori ( H. pylori ) represented one of the most important uses of metronidazole …”