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Ann Intern Med. 2006 Jan 17;144(2):94-100.

Clarithromycin-resistant genotypes and eradication of Helicobacter pylori.

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1
Ospedali Riuniti and University of Foggia, Foggia, Italy.

Abstract

BACKGROUND:

Three point mutations (A2143G, A2142G, and A2142C) have been involved in Helicobacter pylori clarithromycin resistance.

OBJECTIVE:

To compare the eradication rates among the different point mutations and the efficacy of triple therapy and a sequential regimen according to genotypic resistance.

DESIGN:

Post hoc subgroup study from a multicenter, randomized trial.

SETTING:

Two hospitals in central and southern Italy between January and December 2001.

PATIENTS:

156 patients with H. pylori infection.

MEASUREMENTS:

Real-time polymerase chain reaction for assessing clarithromycin resistance; histology, rapid urease test, and 13C-urea breath test at entry and after 4 to 6 weeks.

INTERVENTION:

7-day triple therapy (20 mg of rabeprazole, 500 mg of clarithromycin, and 1 g of amoxicillin) in 75 patients or a 10-day sequential regimen (20 mg of rabeprazole plus 1 g of amoxicillin for 5 days and 20 mg of rabeprazole, 500 mg of clarithromycin, and 500 mg of tinidazole for the remaining 5 days) in 81 patients. All drugs were given twice daily.

RESULTS:

Helicobacter pylori infection was eradicated in 11 of 23 patients (48%) with the A2143G mutation and in 14 of 15 patients (93%) with either A2142G or A2142C strains (difference, 45 percentage points [95% CI, 15 to 65 percentage points]; P = 0.004). The sequential regimen achieved a higher cure rate than triple therapy in A2143G mutate strains (difference, 49 percentage points [CI, 8 to 72 percentage points]; P = 0.024).

LIMITATIONS:

The post hoc substudy design may require further confirmation. Other limitations are the accessibility to the tool and the cost of investigations (70 euros per patient).

CONCLUSIONS:

The A2143G mutation seemed to be associated with a very low eradication rate. The sequential regimen achieved a higher cure rate than standard therapy even in patients with these strains.

PMID:
16418408
[Indexed for MEDLINE]
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