Optimized high-dose amoxicillin–proton-pump inhibitor dual therapies fail to achieve high cure rates in China

Abstract

Background\Aim:Quadruple daily administration of proton-pump inhibitor (PPI) therapy achieves potent acid inhibition, and combined with amoxicillin, with its pharmacodynamic and pharmacokinetic characteristics, may be efficient for Helicobacter pylori eradication. We compared the efficacy of two optimized high-dose dual therapies with a bismuth-containing quadruple regimen for treating H. pylori infection. Rabeprazole dosages for H. pylori eradication were also evaluated.Patients and Methods:Treatment-naive and H. pylori-positive subjects were recruited and randomly apportioned to three treatment groups: Group A (n = 87), rabeprazole 10 mg plus amoxicillin 750 mg (4 times/day for 14 days); Group B (n = 87), rabeprazole 20 mg plus amoxicillin 750 mg (4 times/day for 14 days); and Group C (n = 89), bismuth-containing quadruple regimen consisting of rabeprazole 20 mg, bismuth 220 mg, amoxicillin 1000 mg, and clarithromycin 500 mg (2 times/day for 14 days). Four weeks after treatment discontinuation, patients were examined for H. pylori infection by 13C-urea breath test. The rates of adverse effects, compliance, and eradication were evaluated.Results:Eradication rates in groups A, B, and C were 78.1, 81.6, and 84.3%, respectively, based on intention-to-treat analysis, or 79.1, 83.5, and 86.2%, according to per-protocol analysis. Rates of adverse events and compliance of the three groups were similar.Conclusion:For treating H. pylori infection, optimized high-dose amoxicillin–PPI dual therapies failed to achieve high cure rates in China and held no advantage over a bismuth-containing quadruple regimen.

High dose PPI-amoxicillin dual therapy for the treatment of Helicobacter pylori infection: a systematic review with meta-analysis

“… 26 – 40 The characteristics of the included trials are shown in Table 1 . Of the 15 trials, 11 were conducted in Asia, 29 – 33 , 35 – 40 3 in Europe, 27 , 28 , 34 and 1 in North America. 26 HDDT was given three times daily in four trials, 26 , 28 , 30 , 34 and four times daily in the others.…”

“… 26 HDDT was given three times daily in four trials, 26 , 28 , 30 , 34 and four times daily in the others. 27 , 29 , 31 – 33 , 35 – 40 Six trials used TT, 26 , 28 – 31 , 36 seven used BQT, 27 , 33 – 35 , 37 , 38 , 40 one used non-BQT, 39 and one used both TT and ST as control regimen. 32 Nine trials recruited treatment-naive patients, 30 , 33 – 40 four recruited treatment-experienced patients, 27 – 29 , 31 one recruited both, 32 and one did not report treatment experience of included patients.…”

“… 27 , 29 , 31 – 33 , 35 – 40 Six trials used TT, 26 , 28 – 31 , 36 seven used BQT, 27 , 33 – 35 , 37 , 38 , 40 one used non-BQT, 39 and one used both TT and ST as control regimen. 32 Nine trials recruited treatment-naive patients, 30 , 33 – 40 four recruited treatment-experienced patients, 27 – 29 , 31 one recruited both, 32 and one did not report treatment experience of included patients. 26 Of the 15 included trials, 12 were published as full-length articles, 26 – 34 , 37 – 39 whereas 3 were conference abstracts.…”

“… 32 Nine trials recruited treatment-naive patients, 30 , 33 – 40 four recruited treatment-experienced patients, 27 – 29 , 31 one recruited both, 32 and one did not report treatment experience of included patients. 26 Of the 15 included trials, 12 were published as full-length articles, 26 – 34 , 37 – 39 whereas 3 were conference abstracts. 35 , 36 , 40 …”

Failure of optimized dual proton pump inhibitor amoxicillin therapy: What now?

“…The current study[ 23 ] tested the Yang et al . hypothesis that “optimized” PPI–amoxicillin dual anti- H. pylori therapy would achieve high cure rates.…”