Abstract
Background and Aim: Increased resistance of Helicobacter pylori to antibiotics has increased the need to develop new first-line treatments for H.pylori. We have prospectively evaluated 10-day sequential versus conventional triple therapy in peptic ulcer patients. Methods: One hundred and fifty-nine patients with peptic ulcer diseases were prospectively randomized to receive 10days of lansoprazole, amoxicillin, and clarithromycin (conventional triple therapy) or 5days of lansoprazole and amoxicillin followed by 5days of lansoprazole, clarithromycin, and metronidazole (sequential therapy). Post-treatment H.pylori status was determined by the 13C-urea breath test. Eradication rates, antibiotic resistance rates by agar dilution method, drug compliance, and side-effects were compared. Results: The intention-to-treat eradication rates were 75.9% (95% CI 66.5-85.3%, 60/79) in the sequential therapy group and 58.7% (95% CI 47.9-69.5%, 47/80) in the conventional triple therapy group (P=0.01), while the per-protocol eradication rates were 86.8% (95% CI 78.7-94.8%, 59/68) and 67.6% (95% CI 56.5-78.7%, 46/68) (P=0.01), respectively. Compliance and side-effects were similar in the two groups. Culture of H.pylori showed that 18.2% were resistant to clarithromycin, 41.9% to metronidazole. Dual resistance to both antibiotics was 9.6%. Conclusions: Although 10-day sequential therapy yielded a higher H.pylori eradication rate than 10-day conventional triple therapy, the sequential therapy protocol did not result in a sufficiently satisfactory eradication rate. This might be related to the higher antibiotics resistance rate especially to dual resistance. More effective regimens are needed to overcome antibiotic resistance in Korea.
| Original language | English |
|---|---|
| Pages (from-to) | 1675-1680 |
| Number of pages | 6 |
| Journal | Journal of Gastroenterology and Hepatology (Australia) |
| Volume | 27 |
| Issue number | 11 |
| DOIs | |
| Publication status | Published - 2012 Nov 1 |
| Externally published | Yes |
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Keywords
- Antibiotics resistance
- Clarithromycin
- Helicobacter pylori
- Metronidazole
- Peptic ulcer disease
ASJC Scopus subject areas
- Hepatology
- Gastroenterology
Cite this
Ten-day sequential versus triple therapy for Helicobacterpylori eradication : A prospective, open-label, randomized trial. / Chung, Jun Won; Jung, Young Kul; Kim, Yoon Jae; Kwon, Kwang Ahn; Kim, Jung Ho; Lee, Jong Joon; Lee, Sung Min; Hahm, Ki Baik; Lee, Sun Mi; Jeong, Jin Yong; Yun, Sung Cheol.
In: Journal of Gastroenterology and Hepatology (Australia), Vol. 27, No. 11, 01.11.2012, p. 1675-1680.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Ten-day sequential versus triple therapy for Helicobacterpylori eradication
T2 - A prospective, open-label, randomized trial
AU - Chung, Jun Won
AU - Jung, Young Kul
AU - Kim, Yoon Jae
AU - Kwon, Kwang Ahn
AU - Kim, Jung Ho
AU - Lee, Jong Joon
AU - Lee, Sung Min
AU - Hahm, Ki Baik
AU - Lee, Sun Mi
AU - Jeong, Jin Yong
AU - Yun, Sung Cheol
PY - 2012/11/1
Y1 - 2012/11/1
N2 - Background and Aim: Increased resistance of Helicobacter pylori to antibiotics has increased the need to develop new first-line treatments for H.pylori. We have prospectively evaluated 10-day sequential versus conventional triple therapy in peptic ulcer patients. Methods: One hundred and fifty-nine patients with peptic ulcer diseases were prospectively randomized to receive 10days of lansoprazole, amoxicillin, and clarithromycin (conventional triple therapy) or 5days of lansoprazole and amoxicillin followed by 5days of lansoprazole, clarithromycin, and metronidazole (sequential therapy). Post-treatment H.pylori status was determined by the 13C-urea breath test. Eradication rates, antibiotic resistance rates by agar dilution method, drug compliance, and side-effects were compared. Results: The intention-to-treat eradication rates were 75.9% (95% CI 66.5-85.3%, 60/79) in the sequential therapy group and 58.7% (95% CI 47.9-69.5%, 47/80) in the conventional triple therapy group (P=0.01), while the per-protocol eradication rates were 86.8% (95% CI 78.7-94.8%, 59/68) and 67.6% (95% CI 56.5-78.7%, 46/68) (P=0.01), respectively. Compliance and side-effects were similar in the two groups. Culture of H.pylori showed that 18.2% were resistant to clarithromycin, 41.9% to metronidazole. Dual resistance to both antibiotics was 9.6%. Conclusions: Although 10-day sequential therapy yielded a higher H.pylori eradication rate than 10-day conventional triple therapy, the sequential therapy protocol did not result in a sufficiently satisfactory eradication rate. This might be related to the higher antibiotics resistance rate especially to dual resistance. More effective regimens are needed to overcome antibiotic resistance in Korea.
AB - Background and Aim: Increased resistance of Helicobacter pylori to antibiotics has increased the need to develop new first-line treatments for H.pylori. We have prospectively evaluated 10-day sequential versus conventional triple therapy in peptic ulcer patients. Methods: One hundred and fifty-nine patients with peptic ulcer diseases were prospectively randomized to receive 10days of lansoprazole, amoxicillin, and clarithromycin (conventional triple therapy) or 5days of lansoprazole and amoxicillin followed by 5days of lansoprazole, clarithromycin, and metronidazole (sequential therapy). Post-treatment H.pylori status was determined by the 13C-urea breath test. Eradication rates, antibiotic resistance rates by agar dilution method, drug compliance, and side-effects were compared. Results: The intention-to-treat eradication rates were 75.9% (95% CI 66.5-85.3%, 60/79) in the sequential therapy group and 58.7% (95% CI 47.9-69.5%, 47/80) in the conventional triple therapy group (P=0.01), while the per-protocol eradication rates were 86.8% (95% CI 78.7-94.8%, 59/68) and 67.6% (95% CI 56.5-78.7%, 46/68) (P=0.01), respectively. Compliance and side-effects were similar in the two groups. Culture of H.pylori showed that 18.2% were resistant to clarithromycin, 41.9% to metronidazole. Dual resistance to both antibiotics was 9.6%. Conclusions: Although 10-day sequential therapy yielded a higher H.pylori eradication rate than 10-day conventional triple therapy, the sequential therapy protocol did not result in a sufficiently satisfactory eradication rate. This might be related to the higher antibiotics resistance rate especially to dual resistance. More effective regimens are needed to overcome antibiotic resistance in Korea.
KW - Antibiotics resistance
KW - Clarithromycin
KW - Helicobacter pylori
KW - Metronidazole
KW - Peptic ulcer disease
UR - http://www.scopus.com/inward/record.url?scp=84868124449&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84868124449&partnerID=8YFLogxK
U2 - 10.1111/j.1440-1746.2012.07249.x
DO - 10.1111/j.1440-1746.2012.07249.x
M3 - Article
C2 - 22849546
AN - SCOPUS:84868124449
VL - 27
SP - 1675
EP - 1680
JO - Journal of Gastroenterology and Hepatology (Australia)
JF - Journal of Gastroenterology and Hepatology (Australia)
SN - 0815-9319
IS - 11
ER -