Hybrid, concurrent optimized strategies achieve ≥90 percent cure rate in high resistance settings
MONDAY, July 29 (HealthDay News) -- Optimized nonbismuth quadruple regimens, either hybrid or concomitant, have a cure rate of more than 90 percent for Helicobacter pylori (H. pylori) infections, according to a study published in the July issue of Gastroenterology.
Javier Molina-Infante, M.D., from the Hospital San Pedro de Alcantara in Caceres, Spain, and colleagues compared the efficacy of two optimized nonbismuth quadruple regimens among 343 consecutive individuals with H. pylori infection. Participants were randomized to receive hybrid therapy (omeprazole and amoxicillin, twice daily for 14 days, plus clarithromycin and nitroimidazole twice daily for final seven days) or concomitant therapy (same drugs taken concurrently, twice daily for 14 days).
The researchers found that rates of eradication for hybrid and concomitant therapies were 92 and 96.1 percent, respectively (P = 0.07), in per-protocol analysis. The rates were 90 and 91.7 percent, respectively (P = 0.35) in intention-to-treat analysis. Full compliance was high at 95.5 percent. H. pylori strains that were resistant to clarithromycin, metronidazole, and both drugs were seen in 23.5, 33, and 8.8 percent of patients, respectively. Nearly half (51.5 percent) of patients reported mild side effects. The only significant predictor of eradication was compliance greater than 80 percent (odds ratio, 12.5). Compliance was significantly higher for hybrid therapy versus concomitant therapy (98.8 versus 95.2 percent; P = 0.05).
"Optimized nonbismuth quadruple hybrid and concomitant therapies cured more than 90 percent of patients with H. pylori infections in areas of high clarithromycin and metronidazole resistance," the authors write.
Abstract (http://www.gastrojournal.org/article/S0016-5085%2813%2900491-5/abstract )Full Text (subscription or payment may be required) (http://www.gastrojournal.org/article/S0016-5085%2813%2900491-5/fulltext )