Management ofHelicobacter pylorieradication – the influence of structured counselling and follow‐up

Abstract

Aims Helicobacter pylori (H. pylori) eradication rate varies according to the treatment regimen used and other factors, e.g. antimicrobial resistance and patient compliance. The aim of the present study was to evaluate the in¯uence of patient counselling and follow-up on H. pylori eradication rates and to document the effectiveness of a 1 week eradication regimen consisting of lansoprazole (30 mg once daily), amoxicillin (1 g twice daily) and clarithromycin (500 mg twice daily). Methods Seventy-six dyspeptic patients, who at endoscopy were found to have gastritis, duodenitis or ulceration, and a positive H. pylori urease test, were recruited. Patients were randomly assigned to an intervention group (n=38) or a control group (n=38). Intervention patients received their medicines via the hospital pharmacy and were counselled (and followed up) by a hospital pharmacist. Control patients were given a standard advice sheet and referred to their GP who prescribed the same therapy.Results Intervention patients exhibited a statistically signi®cant improvement in the H. pylori eradication rate (94.7% vs 73.7%; P=0.02) and compliance (92.1% vs 23.7; P<0.001). Of the 64 H. pylori eradicated patients, 62 were able to eliminate their antisecretory medication compared with only 12 of the H. pylori persistent patients (P<0.001). A pharmacoeconomic evaluation indicated that counselling and follow-up reduced the direct costs of eradication by approximately £30 per patient. Conclusions Structured patient counselling and follow-up can have a signi®cant effect on H. pylori eradication rates and should be a routine part of therapy.

Home-based medication review in a high risk elderly population in primary care--the POLYMED randomised controlled trial

“…Nevertheless, the finding of no effect on hospital admission is not out of step with similar UK trials [7][8][9][10]. In contrast, a number of trials have been published since 'Polymed' was initiated, which provide evidence in support of interventions that are focused in specific disease areas such as heart failure [14] or gastritis [15].…”

Review: Improving compliance with Helicobacter pylori eradication therapy: when and how?

“…A study carried out in Northern Ireland compared such an approach including informing the patient of the risks of H. pylori infection, structured counselling and follow up to a 'prescription and discharge' strategy. This revealed significantly increased levels of both compliance and eradication in the cohort who had been given greater knowledge of their illness and the importance of compliance stressed [Al-Eidan et al 2002].…”

Effectiveness of different treatment regimens in helicobacter pylori eradication: Ten-year experience of a single institution

“…A national meta-analysis showed that the average Hp eradication rate with PPI-based triple regimens in Turkey had decreased from 84% in 1997 to 55.3% in 2004 (13). Clarithromycin resistance and patient noncompliance are cited as the most important causes of failure with these regimens (14,15). Clarithromycin resistance has reached 50% in Turkey (16).…”