Are first-line Helicobacter pylori eradication therapies alarming?

Öz

Background and Aims: We aimed to assess the efficacy of four different eradication therapies (first-line) in non-ulcer dyspeptic patients in a gastroenterology polyclinic. Materials and Methods: The file information of 248 patients was examined retrospectively. These patients had been diagnosed as non-ulcer dyspepsia via endoscopy. They tested positive for Helicobacter pylori and received eradication therapy for two weeks. Subsequently, they were monitored using the C14 urea breath test after 4-6 weeks. Four first-line eradication therapy regimes were used as follows: Group LAC (n: 114): Lansoprazole 2x30 mg, amoxicillin 2x1000 mg, clarithromycin 2x500 mg; Group LACB (n: 62): Lansoprazole 2x30 mg, amoxicillin 2x1000 mg, clarithromycin 2x500 mg, bismuth subcitrate 4x300 mg; Group PLA (n: 43): proton pump inhibitor (PPI) (standard dose) 2x1, levofloxacin 1x500 mg, amoxicillin 2x1000 mg; Group PBTM (n: 29): PPI (standard dose) 2x1, bismuth subcitrate 4x300 mg, tetracycline 4x500 mg, metronidazole 3?500 mg. Results: The eradication rates were as follows: Group LAC 52.6%, Group LACB 59.7%, Group PLA 60.5%, and Group PBTM 72.4%. The difference in eradication rates between groups was not statistically significant (p=0.261). Conclusions: The resistance of H. pylori to antibiotics is a significant problem. Current H. pylori therapies should be revised and new studies should be conducted.

Anahtar Kelimeler

• Helicobacter pylori, eradication therapy, clarithromycin, amoxicillin, levofloxacin, metronidazole, tetracycline, bismuth subcitrate

Birinci tercih Helikobakter pilori eradikasyon tedavileri alarm mı veriyor?

Öz

Amaç: Helikobakter pilori pozitif nonülser dispepsili hastalarda birinci tercih dört farklı eradikasyon tedavi protokolünün etkinliğinin değerlendirilmesi Gereç ve Yöntem : Gastroenteroloji polikliniğinde endoskopi ile Helikobakter pilori (+) nonülser dispepsi tanısı konan, daha önce eradikasyon tedavisi almamış hastaların dosya bilgileri retrospektif olarak incelendi. 14 günlük eradikasyon tedavisi verilen ve tedavinin bitiminden 4-6 hafta sonra 14C üre nefes testi kontrolü yapılan 248 hastanın dosya bilgisi kaydedildi. Birinci tercih eradikasyon tedavi protokolleri dört gruba ayrıldı. Bunlar; Grup LAK: Lansoprazol 2x30 mg, amoksisilin 2x1000 mg, klaritromisin 2x500 mg Grup LAKB: Lansoprazol 2x30 mg, amoksisilin 2x1000 mg, klaritromisin 2x500 mg, bizmuth subsitrat 4x300 mg Grup PLA: Proton pompa inhibitörü (standart doz) 2x1, levofloksasin 1x500 mg, amoksisilin 2x1000 mg Grup PBTM: Proton pompa inhibitörü (standart doz) 2x1, bizmuth subsitrat 4x300 mg, tetrasiklin 4x500 mg, metronidazol 3x500 mg Bulgular: Grup LAK'da hasta sayısı: 114 ve eradikasyon oranı: %52.6, Grup LAKB'de hasta sayısı: 62 ve eradikasyon oranı: %59.7, Grup PLA'da hasta sayısı: 43 ve eradikasyon oranı: %60.5, Grup PBTM'de hasta sayısı: 29 ve eradikasyon oranı: %72.4 bulundu. Gruplar arasında eradikasyon başarısı açısından istatistiksel olarak anlamlı fark bulunmadı (p=0,261). Sonuç: Antibiyotiklere karşı Helikobakter pilori direnci ciddi bir problem olarak karşımıza çıkmaktadır. Helikobakter pilori tedavilerinin tekrar gözden geçirilmesi ve bu alanda yeni araştırmalara ihtiyaç vardır.

Anahtar Kelimeler

• Helikobakter pilori, eradikasyon tedavisi, klaritromisin, amoksisilin, levofloksasin, metronidazol, tetrasiklin, bizmuth subsitrat

Kaynakça

1. Güliter S, Keleş H, Özkurt ZN, Cengiz DU, Koluk›sa E. Can lansoprazole, amoxicillin, and clarithromycin combination still be used as a first-line therapy for eradication of Helicobacter pylori. Turk J Gastroenterol 2005;16:29-33.
2. Sezgin O, Alt›ntaş E, Üçbilek E, Tataroğlu C. Bizmuth-based therapies fort he first step eradication of Helicobacter pylori. Turk J Gastroenterol 2006;17:90-3.
3. Malfertheiner P, Megraund F, O’Morain C, et al. Current concepts in the management of the Helicobacter pylori infection. Maastricht III Consensus Report. Gut 2007; 56: 772-81.
4. Egan BJ, Katicic M, O'Connor HJ, O'Morain CA. Treatment of Helicobacter pylori. Helicobacter 2007;12(Suppl 1):31-7.
5. Osato MS, Reddy R, Reddy SG, et al. Pattern of primary resistance of Helicobacter pylori to metronidazole or clarithromycin in the United States. Arch Intern Med 2001;161:1217-20.
6. Ulmer HJ, Berkerling A, Gatz G. Recent use of proton pump inhibitor-based triple therapies for eradication of H. pylori a broad data review. Helicobacter 2003;8:95-104.
7. Megraud F, Lehn N, Lind T et all. Antimicrobial susceptibility testing of Helicobacter pylori in a large multicenter trial: the MACH 2 study. Antimicrob Agents Chemother 1999;43:2447-52.
8. Malfertheiner P, Bayerdorffer E, Diete U et al. The GU-MACH study: the effect of 1-week omeprazole triple therapy on Helicobacter pylori infection in patients with gastric ulcer. Alimet Pharmacol Ther 1999;13:703-12.

9. Zanten SJ, Bradette M, Farley A et al. The DU-MACH study: eradication of Helicobacter pylori and ulcer healing in patients with acute duodenal ulcer using omeprazole based triple therapy: Aliment Pharmacol Ther 1999;13:289-95.
10. Neri M, Milano A, Laterza F, et al. Role of antibiotic sensitivity testing before first line Helicobacter eradication treatment . Aliment Pharmacol Ther 2003;18:821-7.
11. Kaday›fç› A, Büyükhatipoğlu, Savaş C, Şimşek İ. Eradication of Helicobacter pylori with triple therapy: An epidemiologic analysis of trends in Turkey over 10 years. Clinical Therapeutics 2006;28:1960-6.
12. Özer B, Serin E, Coşar A, et al. .The comparison of lansoprazole, clarithromycin and amoxicillin with ranitidine bismuth citrate, lansoprazole, clarithromycin and amoxicillin for Helicobacter pylori eradication thearpy. Akademik Gastroenteroloji Dergisi 2004;3:125-8.
13. Sezgin O, Alt›ntaş E, Üçbilek E, Tataroğlu C. Bismuth-based therapies for the first step eradication of Helicobacter pylori. Turk J Gastroenterol 2006;17:90-3.
14. Cammarota G, Cianci R, Cannizzaro O, et al. Efficacy of two oneweek rabeprazole/levofloxacin-based triple therapies for Helicobacter pylori infection. Aliment Pharmacol Ther 2000;14:1339-43.
15. Saad RJ, Schoenfeld P, Kim HM, Chey WD. Levofloxacin-based triple therapy versus bismuth-based quadruple therapy for persistent Helicobacter pylori infection: a meta-analysis. Am J Gastroenterol 2006;101:488-96.
16. Karahan T, Dumlu Ş, Değertekin B, Doğan İ, Görgül A, Ünal S. Helicobacter pylori eradikasyonunda 14 günlük lansoprazol, amoksisilin, levofloksasin ile lansoprazol, amoksisilin, klatritromisin tedavilerinin k›yaslanmas›: Turk J Gatroenterol. 2003;14(Suppl 1):PB 08/32.
17. Dore MP, Maragkoudakis E, Pironti A. Twice-a-day quadruple therapy for eradication of Helicobacter pylori in the elderly. Helicobacter 2006;11:52-5.
18. Wu DC, Hsu PI, Chen A, et al. Randomized comparison of two rescue therapies for Helicobacter pylori infection. Eur J Clin Invest 2006;36:803-9.
19. Ching SS, Sabanathan S, Jenkinson LR. Treatment of Helicobacter pylori in surgical practice: a randomised trial of triple versus quadruple therapy in a rural district general hospital.World J Gastroenterol 2008;14:3855-60.
20. Khatibian M, Ajvadi Y, Nasseri-Modhaddam S, et al. Furazolidonibased, metronidazole-based, or a combination regimen for eradication of Helicobacter pylori in peptic ulcer disease. Arch Iranian Med 2007;10:161-7.
21. Uygun A, Kaday›fç› A, Safal› M, et al. The efficacy of bismuth containing quadruple therapy as a first-line treatment option for Helicobacter pylori. J Dig Dis 2007;8:211-5.
22. Bağlan HP, Özden A. Helicobacter pylori’nin antibiyotiklere direnci. Güncel Gastroenteroloji 2003;7:220-5.