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Dig Dis Sci. 2016 Nov;61(11):3215-3220. Epub 2016 Sep 22.

Helicobacter pylori Eradication with Proton Pump Inhibitors or Potassium-Competitive Acid Blockers: The Effect of Clarithromycin Resistance.

Author information

1
Department of Internal Medicine, Kawasaki Medical School, 577 Matsushima, Kurashiki City, Okayama Prefecture, 701-0192, Japan.
2
Department of Internal Medicine, Kawasaki Medical School, 577 Matsushima, Kurashiki City, Okayama Prefecture, 701-0192, Japan. shiotani@med.kawasaki-m.ac.jp.
3
Department of Medicine, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX, USA.

Abstract

BACKGROUND:

Vonoprazan is a novel potassium-competitive acid blocker (P-CAB) recently approved for Helicobacter pylori eradication therapy in Japan.

AIMS:

To compare PPI- and P-CAP-containing triple therapy and vonoprazan-based triple therapy.

METHODS:

Two hundred ninety-five initial subjects received a PPI-containing triple therapy; the next 125 subjects received vonoprazan-containing triple therapy. Two sequential groups received 7-day eradication regimens consisting of amoxicillin 750 mg, clarithromycin 200 mg both twice a day with standard dose PPI or vonoprazan (20 mg) each twice daily. H. pylori eradication was confirmed by a 13C-UBT. Clarithromycin susceptibility was evaluated by 23S rRNA PCR.

RESULTS:

Population cure rates with clarithromycin susceptible strains were 89.6 versus 100 % for PPI and vonoprazan therapies, respectively. Cure rates with resistant strains were 40.2 % with PPI therapy versus 76.1 % with vonoprazan triple therapy. There was no difference in side effects.

CONCLUSIONS:

Although 7-day P-CAB triple therapy was superior to 7-day PPI triple therapy, neither was highly effective, or can be recommended, in the presence of clarithromycin-resistant infections.

KEYWORDS:

Clarithromycin resistance; Eradication; Helicobacter pylori; Potassium-competitive acid blockers

PMID:
27659671
DOI:
10.1007/s10620-016-4305-0
[Indexed for MEDLINE]

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