PMID- 22759326
OWN - NLM
STAT- MEDLINE
DCOM- 20121101
LR  - 20131121
IS  - 1523-5378 (Electronic)
IS  - 1083-4389 (Linking)
VI  - 17
IP  - 4
DP  - 2012 Aug
TI  - Nonbismuth quadruple (concomitant) therapy: empirical and tailored efficacy 
      versus standard triple therapy for clarithromycin-susceptible Helicobacter pylori 
      and versus sequential therapy for clarithromycin-resistant strains.
PG  - 269-76
LID - 10.1111/j.1523-5378.2012.00947.x [doi]
AB  - BACKGROUND: Using quadruple clarithromycin-containing regimens for Helicobacter 
      pylori eradication is controversial with high rates of macrolide resistance. AIM: 
      To evaluate antibiotic resistance rates and the efficacy of empirical and 
      tailored nonbismuth quadruple (concomitant) therapy in a setting with cure rates 
      <80% for triple and sequential therapies. METHODS: 209 consecutive naive H. 
      pylori-positive patients without susceptibility testing were empirically treated 
      with 10-day concomitant therapy (proton pump inhibitors (PPI), amoxicillin 1 g, 
      clarithromycin 500 mg, and metronidazole 500 mg; all drugs b.i.d.). 
      Simultaneously, 89 patients with positive H. pylori culture were randomized to 
      receive triple versus concomitant therapy for clarithromycin-susceptible H. 
      pylori, and sequential versus concomitant therapy for clarithromycin-resistant 
      strains. Eradication was confirmed with (1)(3)C-urea breath test or histology 8 weeks 
      after completion of treatment. RESULTS: Per-protocol (PP) and intention-to-treat 
      eradication rates after empirical concomitant therapy without susceptibility 
      testing were 89% (95%CI:84-93%) and 87% (83-92%). Antibiotic resistance rates 
      were: clarithromycin, 20%; metronidazole, 34%; and both clarithromycin and 
      metronidazole, 10%. Regarding clarithromycin-susceptible H. pylori, concomitant 
      therapy was significantly better than triple therapy by per protocol [92% 
      (82-100%) vs 74% (58-91%), p = 0.05] and by intention to treat [92% (82-100%) vs 
      70% (57-90%), p = 0.02]. As for antibiotic-resistant strains, eradication rates 
      for concomitant and sequential therapies were 100% (5/5) vs 75% (3/4), for 
      clarithromycin-resistant/metronidazole-susceptible strains and 75% (3/4) vs 60% 
      (3/5) for dual-resistant strains. CONCLUSIONS: Empirical 10-day concomitant 
      therapy achieves good eradication rates, close to 90%, in settings with 
      multiresistant H. pylori strains. Tailored concomitant therapy is significantly 
      superior to triple therapy for clarithromycin-susceptible H. pylori and at least 
      as effective as sequential therapy for resistant strains.
CI  - (c) 2012 Blackwell Publishing Ltd.
FAU - Molina-Infante, Javier
AU  - Molina-Infante J
AD  - Department of Gastroenterology, Hospital San Pedro de Alcantara, Caceres, Spain. 
      xavi_molina@hotmail.com
FAU - Pazos-Pacheco, Carmen
AU  - Pazos-Pacheco C
FAU - Vinagre-Rodriguez, Gema
AU  - Vinagre-Rodriguez G
FAU - Perez-Gallardo, Belen
AU  - Perez-Gallardo B
FAU - Duenas-Sadornil, Carmen
AU  - Duenas-Sadornil C
FAU - Hernandez-Alonso, Moises
AU  - Hernandez-Alonso M
FAU - Gonzalez-Garcia, Guadalupe
AU  - Gonzalez-Garcia G
FAU - Mateos-Rodriguez, Jose M
AU  - Mateos-Rodriguez JM
FAU - Fernandez-Bermejo, Miguel
AU  - Fernandez-Bermejo M
FAU - Gisbert, Javier P
AU  - Gisbert JP
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
DEP - 20120330
PL  - England
TA  - Helicobacter
JT  - Helicobacter
JID - 9605411
RN  - 0 (Anti-Bacterial Agents)
RN  - 0 (Proton Pump Inhibitors)
RN  - 140QMO216E (Metronidazole)
RN  - 804826J2HU (Amoxicillin)
RN  - H1250JIK0A (Clarithromycin)
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Amoxicillin/therapeutic use
MH  - Anti-Bacterial Agents/*therapeutic use
MH  - Clarithromycin/*therapeutic use
MH  - *Drug Resistance, Bacterial
MH  - Drug Therapy, Combination
MH  - Female
MH  - Helicobacter Infections/*drug therapy/microbiology
MH  - Helicobacter pylori/*drug effects/physiology
MH  - Humans
MH  - Male
MH  - Metronidazole/*therapeutic use
MH  - Middle Aged
MH  - Proton Pump Inhibitors/therapeutic use
MH  - Young Adult
EDAT- 2012/07/05 06:00
MHDA- 2012/11/02 06:00
CRDT- 2012/07/05 06:00
PHST- 2012/07/05 06:00 [entrez]
PHST- 2012/07/05 06:00 [pubmed]
PHST- 2012/11/02 06:00 [medline]
AID - 10.1111/j.1523-5378.2012.00947.x [doi]
PST - ppublish
SO  - Helicobacter. 2012 Aug;17(4):269-76. doi: 10.1111/j.1523-5378.2012.00947.x. Epub 
      2012 Mar 30.