Comparison between different first-line therapy protocols in eradicating Helicobacter pylori in a region with high clarithromycin resistance

OpenAlex İngilizce

Introduction: Helicobacter pylori infection is encountered in more than 50% of the world population.A high rate of clarithromycin resistance is observed among Helicobacter pylori strains in some regions because clarithromycin is a drug commonly used for the treatment of other infections.Aim: To identify an efficient eradication protocol for patients infected with H. pylori and to suggest an alternative first-line therapy particularly in countries with high clarithromycin resistance.Material and methods: Patients (18-75 years old) having dyspeptic complaints in a 1-year period and diagnosed with H. pylori infection by gastric biopsy were included and randomised to three groups, each receiving different sequential eradication therapy (LAM-B: lansoprazole, amoxicillin, metronidazole, bismuth: LAM-T: lansoprazole, amoxicillin, metronidazole, tetracycline; LAM-BT: lansoprazole, amoxicillin, metronidazole, bismuth, tetracycline).Eradication was evaluated via urea breath test.Results: This study included 166 patients (mean age: 40 ±12 years; female, 68.7%) with H. pylori infection.Among them, 50 (30.1%)were in the LAM-B group, 59 (35.5%) were in the LAM-T group, and 57 (34.3%) were in the LAM-BT group.The non-steroidal anti-inflammatory drug use was the lowest in the LAM-BT group.Eradication rates were over 80% and similar in each group, with the highest rate in the LAM-BT group (93%).Adverse event rate was the highest in the LAM-T group.Helicobacter pylori eradication was achieved in 143 (86.1%) patients.Conclusions: The combination regimens without clarithromycin achieved an eradication rate over 80% in all groups.Knowing and monitoring the regional antibiotic resistance rates is important for successful treatment of H. pylori infections.