Short‐course therapy with amoxycillin–clarithromycin triple therapy for 10 days (ACT‐10) eradicates Helicobacter pylori and heals duodenal ulcer

Abstract

Background: Whilst the role of Helicobacter pylori eradication in managing duodenal ulcers has been established, consensus regarding the ideal regimen has not been achieved. Methods: Patients with H. pylori‐positive active duodenal ulcer were randomly assigned to receive triple therapy with amoxycillin 1000 mg b.d. + clarithromycin 500 mg b.d. + omeprazole 20 mg daily for 10 days (ACT‐10) or dual therapy with clarithromycin 500 mg t.d.s. + omeprazole 40 mg daily for 14 days (Dual). No additional acid suppression was provided following eradication therapy. Endoscopy, with biopsy for culture and histology, as well as 13C‐urea breath testing (13C‐UBT) were performed pre‐treatment to assess H. pylori infection. H. pylori eradication was established at 4–6 weeks follow‐up with culture (2 antral, 1 corpus biopsies), histology (2 antral biopsies), and 13C‐UBT. Ulcer healing by endoscopy and change in clinical symptoms were also assessed at 4–6 weeks. Results: Two hundred and sixty‐seven (267) patients were randomized to ACT‐10 (n=137) or Dual therapy (n=130). By per‐protocol and intention‐to‐treat analyses, H. pylori eradication at 4–6 weeks follow‐up was 91% (115/127) and 88% (120/136), respectively, for ACT‐10 patients and 59% (68/115) and 55% (72/130), respectively, for Dual therapy patients (P<0.001 for both analyses). Ulcer healing was high in both treatment groups: ACT‐10, 93% (118/127) and 90% (122/136), respectively; and Dual therapy, 91% (104/114) and 85% (111/130), respectively. Pre‐treatment resistance to clarithromycin was low (4%, 8/214) as compared to metronidazole resistance which was over 40%. Emergence of resistance to clarithromycin was observed in 2% of patients receiving ACT‐10 and in 25% of those receiving Dual therapy. ACT‐10 and Dual therapy patients experienced similar rates of drug‐related adverse events (33% vs. 32%, respectively) and discontinuation from therapy due to an adverse event (1.5% vs. 5%, respectively). More than 90% of patients were compliant with each prescribed medication. Conclusion: In patients with active duodenal ulcer, a 10‐day course of amoxycillin–clarithromycin‐based triple therapy without additional acid suppression is highly effective in eradicating H. pylori and healing duodenal ulcer.

A Comparison of 10 and 14 Days of Lansoprazole Triple Therapy for Eradication of Helicobacter pylori

“…31,32 As expected based on the results of others, 33 we found the H pylori eradication rate of a clarithromycin-containing triple therapy regimen is compromised in patients infected with a clarithromycinresistant organism: H pylori eradication in 94% of patients infected with clarithromycin-susceptible strains and 47% of patients with clarithromycin-resistant strains. Our results are also consistent with those of Wurzer et al 34 and Schwartz et al, 29 who suggested that secondary clarithromycin resistance develops infrequently among patients treated with a proton pump inhibitor combined with clarithromycin and another antibiotic.…”

Changing Antimicrobial Susceptibility Epidemiology of Helicobacter pylori Strains in Japan between 2002 and 2005

“…Factors contributing to eradication include reduced compliance to medication schedules, genetic polymorphisms of drug-metabolizing enzymes, and increased resistance to antimicrobial agents (2,7,26). It was previously reported that resistance to CLR among H. pylori isolates in Japan has been increasing (1,9,11,14,27). It can be speculated that inadequate empirical treatment due to a lack of current antimicrobial susceptibility data is exacerbating the problem of increasing resistance.…”

“…In particular, the relative clinical effectiveness of low-dose longterm therapy with macrolides in the treatment of chronic respiratory infections may account for the failure of H. pylori eradication in those patients. The high failure rate observed when CLR is employed in an eradication regimen in the presence of CLR-resistant strains as well as the association of eradication failure and CLR resistance have been reported (9,27). The not-uncommon occurrence of suboptimal eradication therapy would predict a further increase in the incidence of CLR-resistant H. pylori strains.…”

Duodenal ulcer healing with 1‐week eradication triple therapy followed, or not, by anti‐secretory treatment: a multicentre double‐blind placebo‐controlled trial

“…Most of those studies were conducted with a 10-14-day regimen, 3,4,6,8 or with a colloidal bismuth subcitrate. 11 However, one study using a 1-week triple therapy, without prolongation of the anti-secretory drug, has shown that approximately 80% of H. pylori-associated duodenal ulcers were healed after 28 days.…”

“…However, several studies have suggested that treatment for eradication of H. pylori without prolongation of anti-secretory treatment is sufficient to heal most of the duodenal ulcer. [1][2][3][4][5][6][7][8][9] The present study tests the hypothesis that the 1-week triple therapy for eradication of H. pylori alone is a convenient therapy regimen for uncomplicated H. pylori-associated duodenal ulcer.…”