Efficacy of low‐dose clarithromycin triple therapy and tinidazole‐containing triple therapy for Helicobacter pylori eradication

Abstract

Background: Proton pump inhibitor‐based triple therapies are recommended as the first‐line treatment for Helicobacter pylori eradication. Aim: To evaluate the efficacies of low‐dose clarithromycin triple therapy and tinidazole‐containing triple therapy in a metronidazole resistance prevalent area and to compare the efficacies with standard triple therapy. Methods: In a randomized, multicentre, prospective study, a total of 352 patients with duodenal ulcer or non‐ulcer dyspepsia were randomly divided into three groups according to the administered regimen: OAC250 group (omeprazole, 20 mg, amoxicillin, 1000 mg, and clarithromycin, 250 mg), OAC500 group (omeprazole, 20 mg, amoxicillin, 1000 mg, and clarithromycin, 500 mg) and OTC group (omeprazole, 20 mg, tinidazole, 500 mg, and clarithromycin, 500 mg). The three groups received each regimen twice daily for 7 days. Upper gastrointestinal endoscopy was performed before and 4 weeks after treatment. H. pylori status was determined by rapid urease test and 13C urea breath test. Results: The eradication rates in the OAC250, OAC500 and OTC groups were 76.2%, 65.7% and 64.8% (95% confidence interval: 67.9–84.4%, 56.7–74.8% and 55.7–73.9%), respectively, by intention‐to‐treat analysis (P=0.149) and 92.8%, 87.2% and 84.1% (95% confidence interval: 84.4–97.3%, 77.9–93.8% and 73.9–91.2%), respectively, by per protocol analysis (P=0.088). All regimens were well tolerated and compliance was excellent. Conclusions: Both low‐dose clarithromycin triple therapy and tinidazole‐containing triple therapy are effective and safe regimens for H. pylori eradication.

Comparison of 7‐day and 14‐day Proton Pump Inhibitor‐Containing Triple Therapy for Helicobacter pylori Eradication: Neither Treatment Duration Provides Acceptable Eradication Rate in Korea

“…It may be possible that the longer duration of treatment raises the eradication rate, but if the cause of treatment failure is antibiotic resistance, the extension of treatment period is not expected to raise the eradication rate. In this study, H. pylori eradication rate of PAC7 group did not show significant difference when compared with the recent trial conducted in Korea [17]. Previous study that compared the efficacies of omeprazolecontaining triple regimen (omeprazole 40 mg + amoxicillin 2000 mg + clarithromycin 1000 mg/day) continued for 7, 10, or 14 days did not show any difference in eradication rates, with increasing trend of poor compliance as treatment period was extended [18].…”

Helicobacter pylori eradication and peptic ulcer healing: the impact of deleting the proton pump inhibitor and using a once‐daily treatment

“…A majority of the larger studies have used higher antibiotic dosages than ours, leading to higher treatment costs for the patients. In spite of the different designs, most studies have reported eradication rates around 90%, 23 , 24 with the exception of an open, non‐controlled study from Brazil, which used the same regimen as ours and reported an eradication rate of only 65% 25 . A recent, non‐blind trial from Vietnam found an eradication rate of 91% with a regimen of amoxicillin, clarithromycin and omeprazole for 10 days 26 .…”

Helicobacter pylori infection in geriatrics

“…However, recent studies suggest that [36] mechanisms other than age, i.e. a stronger synergism of clarithromycin plus metronidazole, even at low doses, than of clarithromycin plus amoxicillin, may be involved in the therapeutic response of PPI-based triple therapies [42,43].…”