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Helicobacter pylori: High dose amoxicillin does not improve primary or secondary eradication rates in an Irish cohort
Conor Costigan1,2, Aoife M O'Sullivan3, Jim O'Connell3
1Trinity Academic Gastroenterology Group, School of Medicine-Trinity College Dublin, Dublin D2, Ireland.
Insights
High-dose amoxicillin dual therapy (HDADT) for Helicobacter pylori eradication showed disappointing results in an Irish cohort, with a 56% overall success rate. This regimen is not recommended for routine use in areas with high antibiotic resistance.
Area of Science:
- Gastroenterology
- Infectious Diseases
- Pharmacology
Background:
- Global Helicobacter pylori eradication rates are declining due to increasing antibiotic resistance.
- High-dose amoxicillin dual therapy (HDADT) is suggested by Maastricht VI guidelines for areas with high clarithromycin and metronidazole resistance.
- Local efficacy data is crucial for considering HDADT in such regions.
Purpose of the Study:
- To evaluate the efficacy of HDADT for H. pylori eradication in an Irish patient cohort.
- To assess HDADT as both a first-line and subsequent treatment option.
- To provide local evidence for the use of HDADT in a high-resistance area.
Main Methods:
- Prospective study of 139 H. pylori-positive patients treated with HDADT (amoxicillin 1g tid, esomeprazole 40mg bid x 14 days).
- Eradication confirmed via Urea Breath Test at least 4 weeks post-therapy.
- Analysis controlled for patient demographics and prior H. pylori treatment history.
Main Results:
- Overall eradication rate was 56% (78/139), which is considered disappointing.
- Eradication rates were significantly lower in patients with prior treatment (43%) compared to treatment-naïve patients (62%).
- High compliance (97%) and low incidence of mild side-effects (7%) were reported, with no serious adverse events.
Conclusions:
- HDADT demonstrated disappointing eradication rates in this Irish cohort, falling short of the desired >90% target.
- The study does not support the routine use of HDADT in countries with high dual antibiotic resistance.
- Further research into alternative H. pylori eradication regimens is necessary.
Background:
Helicobacter pylori (H. pylori) eradication rates have fallen globally, likely in large part due to increasing antibiotic resistance to traditional therapy. In areas of high clarithromycin and metronidazole resistance such as ours, Maastricht VI guidelines suggest high dose amoxicillin dual therapy (HDADT) can be considered, subject to evidence for local efficacy. In this study we assess efficacy of HDADT therapy for H. pylori eradication in an Irish cohort.
Aim:
To assess the efficacy of HDADT therapy for H. pylori eradication in an Irish cohort as both first line, and subsequent therapy for patients diagnosed with H. pylori.
Methods:
All patients testing positive for H. pylori in a tertiary centre were treated prospectively with HDADT (amoxicillin 1 g tid and esomeprazole 40 mg bid × 14 d) over a period of 8 months. Eradication was confirmed with Urea Breath Test at least 4 wk after cessation of therapy. A delta-over-baseline > 4% was considered positive. Patient demographics and treatment outcomes were recorded, analysed and controlled for basic demographics and prior H. pylori treatment.
Results:
One hundred and ninety-eight patients were identified with H. pylori infection, 10 patients were excluded due to penicillin allergy and 38 patients refused follow up testing. In all 139 were included in the analysis, 55% (n = 76) were female, mean age was 46.6 years. Overall, 93 (67%) of patients were treatment-naïve and 46 (33%) had received at least one previous course of treatment. The groups were statistically similar. Self-reported compliance with HDADT was 97%, mild side-effects occurred in 7%. There were no serious adverse drug reactions. Overall the eradication rate for our cohort was 56% (78/139). Eradication rates were worse for those with previous treatment [43% (20/46) vs 62% (58/93), P = 0.0458, odds ratio = 2.15]. Age and Gender had no effect on eradication status.
Conclusion:
Overall eradication rates with HDADT were disappointing. Despite being a simple and possibly better tolerated regime, these results do not support its routine use in a high dual resistance country. Further investigation of other regimens to achieve the > 90% eradication target is needed.
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