Short-term triple therapy with azithromycin for Helicobacter pylori eradication: Low cost, high compliance, but low efficacy

Silva, Fernando M.; Eisig, Jaime Natan; Teixeira, Ana Cristina Sá; Navarro–Rodriguez, Tomás; Mattar, Rejane

doi:10.1186/1471-230x-8-20

Cited by 9 publications

(8 citation statements)

References 42 publications

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“…In Brazil, a country of continental dimensions, the majority of practicing clinicians employ the classical triple regimen composed of clarithromycin, amoxicillin and a proton pump inhibitor for seven days as first line therapy to overcome H. pylori infection [ 5 , 14 ]. This regimen has been proved to become inefficient worldwide, mainly as a result of the emergence and increase of H. pylori strains resistant to clarithromycin, which reduces the bacterium treatment efficiency from 55% to 100% [ 15 - 18 ].…”

Section: Introductionmentioning

confidence: 99%

Low Helicobacter pylori primary resistance to clarithromycin in gastric biopsy specimens from dyspeptic patients of a city in the interior of São Paulo, Brazil

Suzuki

Lopes

et al. 2013

BMC Gastroenterol

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BackgroundClarithromycin, amoxicillin, and a pump proton inhibitor are the most common drugs recommended as first-line triple therapy for H.pylori treatment, which results in eradication rates close to 80%, varying regionally, principally due to emergency cases and increases of clarithromycin resistant strains. Nucleotide substitutions at the H. pylori domain V of the 23S rRNA fraction are involved in the macrolide resistance and the A2142G and A2143G mutations are predominant in clinical isolates worldwide including in Brazil. As H. pylori culture is fastidious, we investigated the primary occurrence of H. pylori A2142G and A2143G rDNA 23S mutations using a molecular approach directly on gastric biopsies of dyspeptic patients consecutively attended at Hospital das Clinicas of Marilia, São Paulo, Brazil.MethodsBiopsy specimens obtained from 1137 dyspeptic patients, were subjected to histopathology and H. pylori diagnosis by histology and PCR. PCR/RFLP assay was used to detect A2142G and A2143G point mutations at domain V of the H. pylori 23S rDNA associated with clarithromycin resistance. Through the developed assay, a 768 bp PCR amplicon corresponding to1728 to 2495 bp of the 23S H. pylori rDNA is restricted with MboII for A2142G mutation detection and with BsaI for A2143G mutation detection. Occurrence of 23S rDNA A2142G results in two DNA fragments (418 and 350 bp) and of 23S rDNA A2143G results in three DNA fragments (108, 310 and 350pb), due to a conserved BsaI restriction site.ResultsThe PCR method used to diagnose H. pylori presented sensitivity, specificity and accuracy of 77,6%, 79,3% and 78,6%, respectively, compared to histology, the gold standard method for H. pylori diagnosis used in our routine. Prevalence of H.pylori with clarithromycin resistant genotypes was 2,46%, with predominance of A2143G 23S rDNA point mutation.ConclusionsThe PCR/RFLP assay was a rapid and accurate H.pylori diagnostic and clarithromycin resistance determination method useful for routine practice. As prevalence of primary resistance of H.pylori to clarithromycin due to A2142G and A2143G mutations remains low in Marilia, the standard clarithromycin containing triple therapy is still valid.

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Section: Introductionmentioning

confidence: 99%

Low Helicobacter pylori primary resistance to clarithromycin in gastric biopsy specimens from dyspeptic patients of a city in the interior of São Paulo, Brazil

Suzuki

Lopes

et al. 2013

BMC Gastroenterol

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“…One meta-analysis found that when azithromycin was used, the eradication rate was 72% (compared to 70% when it was not used) (Dong et al, 2009). One study, however, does not share the optimism associated with the use of azithromycin for H. pylori eradication; this study found low eradication rates (at around 40%) when using azithromycin and concluded that it should not be recommended for H. pylori infection (Silva et al, 2008). If you look again at Table 2.3.2 (which shows the common treatment regimens for eradicating H. pylori), this is clearly advantageous given the complexity and multiple dosing of the other regimens (that is, patients will find azithromycin-containing regimens easier to take, which should improve compliance with therapy).…”

Section: Eradication Of Helicobacter Pylorimentioning

confidence: 86%

Macrolide Antibiotics

2012

Antibacterial Agents

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“…Other studies showed that both azithromycin and clarithromycin achieve high extracellular concentrations (30). However, the shorter half-life of clarithromycin may increase the dissemination of H. pylori-resistant organisms into the community (31).…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2012

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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.

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Short-term triple therapy with azithromycin for Helicobacter pylori eradication: Low cost, high compliance, but low efficacy

Cited by 9 publications

References 42 publications

Low Helicobacter pylori primary resistance to clarithromycin in gastric biopsy specimens from dyspeptic patients of a city in the interior of São Paulo, Brazil

Low Helicobacter pylori primary resistance to clarithromycin in gastric biopsy specimens from dyspeptic patients of a city in the interior of São Paulo, Brazil

Macrolide Antibiotics

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

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