Comparison of Azithromycin and Clarithromycin Triple Therapy Regimens for Helicobacter Pylori Eradication in hemodialysis Patients

Abstract

BackgroundHelicobacter pylori eradication with clarithromycin is more expensive than with azithromycin.ObjectivesThis study aimed to compare the effectiveness of these two antibiotics in eradicating H. pylori in hemodialysis (HD) patients.Patients and MethodsThis is a prospective, randomized, double-blinded clinical trial analysis of HD patients. Patients who had dyspepsia and showed positive results for two of three tests, anti-H. pylori serology, H. pylori stool antigen (HpSAg), or Urease Breath Test (UBT), were included in the study. The subjects consisted of 39 dialysis patients who were randomly divided into two groups that received medication twice daily. Group OAC received 20 mg omeprazol, 500 mg amoxycilin, and 250 mg clarithromycin, and Group OAAz received 20 mg omeprazol, 500 mg amoxicillin, and 250 mg azithromycin. Both regimens were administered for 14 days. Eradication was investigated by performing the UBT and the HpSAg test eight weeks later.ResultsThis study began with 39 patients, 37 of which completed the treatment schedule (20 males and 17 females, mean age 59 years). Two patients died due to MI before beginning treatment. In the OAC group, negative results on the UBT and HpSAg tests were found in 82.4% and 88.2% of the participants, respectively. In the OAAz group, these values were 80% and 85%, respectively. The data showed that the difference between the two regimens was not significant (P = 1.0).ConclusionsAccording to the data, no differences in eradication rates were apparent between the azitromycin and the claritromycin regimens. However, lower cost and fewer complaints could be considered as an advantage of the triple therapy with azithromycin.

Revisão do perfil de eficácia da terapia tripla com Azitromicina na erradicação do Helicobacter pylori

“…Diversos estudos têm comparado a eficácia da Azitromicina e da Claritromicina na erradicação do H. pylori. Estudos indicam que a Azitromicina possui um perfil de segurança favorável e é uma alternativa viável à Claritromicina, especialmente em termos de custo-benefício (Sarkeshikian et al, 2012;Jalalzadeh et al, 2014). A Azitromicina é geralmente mais acessível em termos de custo.…”

Eradication Therapy for Helicobacter pylori Infection in Patients Receiving Hemodialysis: Review

“…For meta‐analysis aimed at updating the Japanese guideline for H. pylori infection in clinical practice, this meta‐analysis was conducted using data from RCTs and observational cohort study identified by searching the medical literature on two kinds of databases, namely PubMed and Cochrane Library databases (Figure S2). We divided studies investigated the efficacy and safety of eradication therapy for patients receiving HD into three categories: (1) comparison of patients receiving HD with healthy individuals having normal renal function using observational cohort study (Study 1, Table 1) [26–33], (2) comparison of patients receiving HD with patients with non‐HD CKD based on observational cohort study (Study 2, Table 2) [29, 30, 32, 34], and (3) randomized controlled trial among patients receiving HD (Study 3, Table 3) [29, 31, 33, 35–39]. We compared H. pylori eradication rates of first‐line therapy lasting for 7–14 days among patients receiving HD.…”

“…1, Table1)[26][27][28][29][30][31][32][33], (2) comparison of patients receiving HD with patients with non-HD CKD based on observational cohort study (Study 2, Table2)[29,30,32,34], and (3) randomized controlled trial among patients receiving HD (Study 3, Table3)[29,31,33,[35][36][37][38][39]. We compared H. pylori eradication rates of first-line therapy lasting for 7-14 days among patients receiving HD.Abbreviations: AMPC, amoxicillin; AZM, azithromycin; bid, twice-daily dosing; CAM, clarithromycin; CIP, ciprofloxacin; EPZ, esomeprazole; FUR, furazolidone; HD, hemodialysis; ITT, intention-to-treat; LPZ, lansoprazole; LVFX, levofloxacin; NA, not available; od, once-daily dosing; OPZ, omeprazole; PP, per protocol; PPI, proton pump inhibitor; PPZ, pantoprazole; RCT, randomized control trial; TNZ, tinidazole.…”

Hemodialysis Adequacy Sacrificed for Business: A Qualitative Study

“…The high prevalence of symptoms such as fatigue (11), anorexia (12), sleep disorders (13), nausea and vomiting (14), peptic ulcer disease (15), itching (16), blood coagulation disorders (17), hyperparathyroidism (18), infection (19), dysgeusia (20), and blood pressure fluctuations due to inadequate dialysis can undermine the quality of life. Previous studies pinpointed several factors as barriers to adequate dialysis, namely patient -related factors (e g, hypotension, intradialytic symptoms, treatment time missed due to noncompliance or transportation problems, duration < 4 hours, blood flow rate (BFR) < 350 mL/minute, patient weight > 100 kg, and delivered BFR 50 mL/minute less than the prescribed BFR) and technical factors (e g, dialysis prescription, type of vascular access, clotting, and dialyzer reuse) (21)(22)(23).…”