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Efficacy of Tailored Helicobacter pylori Eradication Treatment Based on Clarithromycin Susceptibility and Maintenance of Acid Secretion
Author(s) -
Sugimoto Mitsushige,
Uotani Takahiro,
Sahara Shu,
Ichikawa Hitomi,
Yamade Mihoko,
Sugimoto Ken,
Furuta Takahisa
Publication year - 2014
Publication title -
helicobacter
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.206
H-Index - 79
eISSN - 1523-5378
pISSN - 1083-4389
DOI - 10.1111/hel.12128
Subject(s) - clarithromycin , helicobacter pylori , rabeprazole , amoxicillin , metronidazole , regimen , medicine , proton pump inhibitor , gastroenterology , antibiotics , cyp2c19 , pharmacology , microbiology and biotechnology , biology , cytochrome p450 , metabolism
Background Insufficient acid inhibition during Helicobacter pylori eradication treatment and bacterial resistance to antibiotics often causes eradication failure. Four times daily dosing (q.i.d.) of a proton‐pump inhibitor ( PPI ) achieves potent acid inhibition, suggesting its potential usefulness as a regimen for eradicating H. pylori infection. Therefore, a tailored eradication regimen based on antibiotic susceptibility and maintenance of acid inhibition should have a high success rate. We investigated the efficacy of such treatment based on clarithromycin ( CAM ) susceptibility. Methods Using 153 H. pylori ‐positive Japanese patients, we investigated the efficacy of tailored eradication strategy: (1) Patients infected with CAM ‐sensitive H. pylori were treated with a PPI (rabeprazole 10 mg q.i.d.), amoxicillin 500 mg q.i.d., and CAM 200 mg b.i.d. (n = 89), and (2) patients infected with CAM ‐resistant were given the same doses of rabeprazole and amoxicillin and metronidazole 250 mg b.i.d. (n = 64) for 1 week. Results In the tailored regimen group, the overall eradication rate was 96.7% (95% CI : 92.5–98.9%, 148/153) in the intention‐to‐treat ( ITT ) analysis and 97.4% (93.4–99.3%, 148/152) in the PP analysis. The eradication rates for the CAM ‐ and metronidazole‐based treatments were similar (95.5% and 98.4%, respectively, p = .400). The tailored treatment achieved a high eradication rate in CYP 2C19 rapid metabolizers who were a resistance genotype for PPI treatment (94.3% (86.0–98.4%, 66/70)). Discussion A tailored H. pylori eradication regimen based on CAM susceptibility and maintaining acid secretion (rabeprazole 10 mg q.i.d.) is useful because it can achieve an eradication rate exceeding 95%, irrespective of eradication history, thus overcoming differences among CYP 2C19 genotypes.