PMID- 24599773 OWN - NLM STAT- MEDLINE DCOM- 20140715 LR - 20211021 IS - 1573-2568 (Electronic) IS - 0163-2116 (Linking) VI - 59 IP - 6 DP - 2014 Jun TI - Factors affecting first-line triple therapy of Helicobacter pylori including CYP2C19 genotype and antibiotic resistance. PG - 1235-43 LID - 10.1007/s10620-014-3093-7 [doi] AB - BACKGROUND: Emerging evidence shows that the eradication rate of proton pump inhibitor (PPI)-based triple therapy for the first-line treatment of Helicobacter pylori (H. pylori) has decreased. AIMS: To clarify the trend of eradication rate of PPI-based triple therapy and to assess the related factors in Korea during the past decade. METHODS: We prospectively prescribed the triple regimen for seven days (PPI + amoxicillin 1.0 g + clarithromycin 500 mg, twice a day) from March 2003 to May 2013 in 2,202 H. pylori-positive patients. Antibiotic susceptibility tests were performed by the agar dilution method, and the CYP2C19 genotype was determined by the PCR method. RESULTS: In the past decade, the annual eradication rate showed a decreasing trend in intention-to-treat and per-protocol analyses (P = 0.001, both). The antibiotic resistance was increased to amoxicillin (7.2-17.2%, P = 0.003) and clarithromycin (23.2-37.3%, P = 0.010) during the study period. The poor metabolizer genotype of CYP2C19 showed a high eradication rate compared to the extensive metabolizer (86.8 vs. 78.2%, P = 0.035). In addition, age >/= 50 years, female gender, BMI < 25 kg/m(2), amoxicillin and/or clarithromycin resistance were associated with treatment failure on univariate analysis. However, on multivariate analysis, clarithromycin resistance was the only significant factor for treatment failure (OR, 12.76; 95% CI, 5.58-29.18; P < 0.001). CONCLUSIONS: An increase in clarithromycin resistance has led to decreased eradication rate of first-line triple therapy, and; hence, a new strategy is needed to improve the eradication rate of H. pylori. FAU - Lee, Ju Yup AU - Lee JY AD - Department of Internal Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam, Gyeonggi-do, 463-707, South Korea. FAU - Kim, Nayoung AU - Kim N FAU - Kim, Min Soo AU - Kim MS FAU - Choi, Yoon Jin AU - Choi YJ FAU - Lee, Jung Won AU - Lee JW FAU - Yoon, Hyuk AU - Yoon H FAU - Shin, Cheol Min AU - Shin CM FAU - Park, Young Soo AU - Park YS FAU - Lee, Dong Ho AU - Lee DH FAU - Jung, Hyun Chae AU - Jung HC LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20140306 PL - United States TA - Dig Dis Sci JT - Digestive diseases and sciences JID - 7902782 RN - 0 (Anti-Bacterial Agents) RN - 0 (Proton Pump Inhibitors) RN - 804826J2HU (Amoxicillin) RN - EC 1.14.14.1 (Aryl Hydrocarbon Hydroxylases) RN - EC 1.14.14.1 (CYP2C19 protein, human) RN - EC 1.14.14.1 (Cytochrome P-450 CYP2C19) RN - H1250JIK0A (Clarithromycin) SB - IM MH - Adult MH - Aged MH - Amoxicillin/administration & dosage/pharmacology/therapeutic use MH - Anti-Bacterial Agents/administration & dosage/pharmacology/therapeutic use MH - Aryl Hydrocarbon Hydroxylases/genetics/*metabolism MH - Clarithromycin/administration & dosage/pharmacology/therapeutic use MH - Cytochrome P-450 CYP2C19 MH - *Drug Resistance, Bacterial MH - Female MH - *Genetic Predisposition to Disease MH - *Genotype MH - Helicobacter Infections/*drug therapy/genetics MH - Helicobacter pylori/*drug effects MH - Humans MH - Male MH - Microbial Sensitivity Tests MH - Middle Aged MH - Odds Ratio MH - Proton Pump Inhibitors/administration & dosage/therapeutic use MH - Treatment Failure EDAT- 2014/03/07 06:00 MHDA- 2014/07/16 06:00 CRDT- 2014/03/07 06:00 PHST- 2014/01/19 00:00 [received] PHST- 2014/02/20 00:00 [accepted] PHST- 2014/03/07 06:00 [entrez] PHST- 2014/03/07 06:00 [pubmed] PHST- 2014/07/16 06:00 [medline] AID - 10.1007/s10620-014-3093-7 [doi] PST - ppublish SO - Dig Dis Sci. 2014 Jun;59(6):1235-43. doi: 10.1007/s10620-014-3093-7. Epub 2014 Mar 6.