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Article: Clarithromycin-amoxycillin-containing triple therapy: A valid empirical first-line treatment for helicobacter pylori eradication in Hong Kong?

TitleClarithromycin-amoxycillin-containing triple therapy: A valid empirical first-line treatment for helicobacter pylori eradication in Hong Kong?
Authors
KeywordsClarithromycin
Empirical first-line eradication
Helicobacter pylori
Hong Kong
Levofloxacin
Issue Date2009
PublisherBlackwell Publishing Ltd. The Journal's web site is located at http://www.blackwellpublishing.com/journals/HEL
Citation
Helicobacter, 2009, v. 14 n. 6, p. 505-511 How to Cite?
AbstractBackground: Recent studies have suggested the eradication rate for Helicobacter pylori infection with standard amoxycillin-clarithromycin- containing triple therapy as first-line treatment have fallen below 80%. Levofloxacin-containing triple therapy was proposed as an alternative. The aim of this study is to compare the efficacy and tolerability of the standard 7-day clarithromycin-containing triple therapy against the 7-day levofloxacin- containing triple therapy, and to assess whether the classical triple therapy is still valid as empirical first-line treatment for H. pylori infection in Hong Kong. Methods: Three hundred consecutive H. pylori-positive patients were randomized to receive either 1 week of EAL (esomeprazole 20 mg b.d., amoxycillin 1 g b.d., and levofloxacin 500 mg daily) or EAC (esomeprazole 20 mg b.d., amoxycillin 1 g b.d., and clarithromycin 500 mg b.d.). H. pylori status was rechecked by 13C-urea breath test 6 weeks after treatment. Patients who failed either of the first-line eradication therapy were invited to undergo H. pylori susceptibility testing. Results: H. pylori eradication was achieved in 128 of 150 (85.3%) patients in EAL and 139 of 150 (92.7%) patients in EAC groups, respectively (p =.043), for both intention-to-treat and per-protocol analysis. More patients in the clarithromycin- than the levofloxacin-containing therapy group developed side effects from the medication (21.3% vs 13.3%, p =.060). Nine patients (six from the EAL group and three from the EAC group) who failed their corresponding eradication therapy returned for susceptibility testing. All nine isolates were highly resistant to levofloxacin (minimum inhibitory concentration or MIC > 32 μg/mL), whereas only two of the six isolates from the EAL group were resistant to clarithromycin (MIC > 0.5 μg/mL). Conclusions: The standard 7-day clarithromycin-containing triple therapy is still valid as the most effective empirical first-line eradication therapy for H. pylori infection in Hong Kong, as prevalence of primary resistance of H. pylori to amoxycillin and clarithromycin remains low. Patients who failed their empirical first-line eradication therapy should undergo H. pylori susceptibility testing to guide further treatment. © 2009 Blackwell Publishing Ltd.
Persistent Identifierhttp://hdl.handle.net/10722/77642
ISSN
2015 Impact Factor: 3.92
2015 SCImago Journal Rankings: 1.131
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorHung, IFNen_HK
dc.contributor.authorChan, Pen_HK
dc.contributor.authorLeung, Sen_HK
dc.contributor.authorChan, FSYen_HK
dc.contributor.authorHsu, Aen_HK
dc.contributor.authorBut, Den_HK
dc.contributor.authorSeto, WKen_HK
dc.contributor.authorWong, SYen_HK
dc.contributor.authorChan, CKen_HK
dc.contributor.authorGu, Qen_HK
dc.contributor.authorTong, TSMen_HK
dc.contributor.authorCheung, TKen_HK
dc.contributor.authorChu, KMen_HK
dc.contributor.authorWong, BCYen_HK
dc.date.accessioned2010-09-06T07:34:08Z-
dc.date.available2010-09-06T07:34:08Z-
dc.date.issued2009en_HK
dc.identifier.citationHelicobacter, 2009, v. 14 n. 6, p. 505-511en_HK
dc.identifier.issn1083-4389en_HK
dc.identifier.urihttp://hdl.handle.net/10722/77642-
dc.description.abstractBackground: Recent studies have suggested the eradication rate for Helicobacter pylori infection with standard amoxycillin-clarithromycin- containing triple therapy as first-line treatment have fallen below 80%. Levofloxacin-containing triple therapy was proposed as an alternative. The aim of this study is to compare the efficacy and tolerability of the standard 7-day clarithromycin-containing triple therapy against the 7-day levofloxacin- containing triple therapy, and to assess whether the classical triple therapy is still valid as empirical first-line treatment for H. pylori infection in Hong Kong. Methods: Three hundred consecutive H. pylori-positive patients were randomized to receive either 1 week of EAL (esomeprazole 20 mg b.d., amoxycillin 1 g b.d., and levofloxacin 500 mg daily) or EAC (esomeprazole 20 mg b.d., amoxycillin 1 g b.d., and clarithromycin 500 mg b.d.). H. pylori status was rechecked by 13C-urea breath test 6 weeks after treatment. Patients who failed either of the first-line eradication therapy were invited to undergo H. pylori susceptibility testing. Results: H. pylori eradication was achieved in 128 of 150 (85.3%) patients in EAL and 139 of 150 (92.7%) patients in EAC groups, respectively (p =.043), for both intention-to-treat and per-protocol analysis. More patients in the clarithromycin- than the levofloxacin-containing therapy group developed side effects from the medication (21.3% vs 13.3%, p =.060). Nine patients (six from the EAL group and three from the EAC group) who failed their corresponding eradication therapy returned for susceptibility testing. All nine isolates were highly resistant to levofloxacin (minimum inhibitory concentration or MIC > 32 μg/mL), whereas only two of the six isolates from the EAL group were resistant to clarithromycin (MIC > 0.5 μg/mL). Conclusions: The standard 7-day clarithromycin-containing triple therapy is still valid as the most effective empirical first-line eradication therapy for H. pylori infection in Hong Kong, as prevalence of primary resistance of H. pylori to amoxycillin and clarithromycin remains low. Patients who failed their empirical first-line eradication therapy should undergo H. pylori susceptibility testing to guide further treatment. © 2009 Blackwell Publishing Ltd.en_HK
dc.languageengen_HK
dc.publisherBlackwell Publishing Ltd. The Journal's web site is located at http://www.blackwellpublishing.com/journals/HELen_HK
dc.relation.ispartofHelicobacteren_HK
dc.subjectClarithromycinen_HK
dc.subjectEmpirical first-line eradicationen_HK
dc.subjectHelicobacter pylorien_HK
dc.subjectHong Kongen_HK
dc.subjectLevofloxacinen_HK
dc.subject.meshAdulten_HK
dc.subject.meshAgeden_HK
dc.subject.meshAmoxicillin - therapeutic useen_HK
dc.subject.meshAnti-Bacterial Agents - therapeutic useen_HK
dc.subject.meshClarithromycin - therapeutic useen_HK
dc.subject.meshDrug Therapy, Combination - methodsen_HK
dc.subject.meshFemaleen_HK
dc.subject.meshHelicobacter Infections - drug therapyen_HK
dc.subject.meshHelicobacter pylori - drug effectsen_HK
dc.subject.meshHong Kongen_HK
dc.subject.meshHumansen_HK
dc.subject.meshMaleen_HK
dc.subject.meshMiddle Ageden_HK
dc.subject.meshOfloxacin - therapeutic useen_HK
dc.subject.meshOmeprazole - therapeutic useen_HK
dc.titleClarithromycin-amoxycillin-containing triple therapy: A valid empirical first-line treatment for helicobacter pylori eradication in Hong Kong?en_HK
dc.typeArticleen_HK
dc.identifier.openurlhttp://library.hku.hk:4550/resserv?sid=HKU:IR&issn=1083-4389&volume=14&spage=505&epage=511&date=2009&atitle=Clarithromycin-amoxycillin-containing+triple+therapy:+A+valid+empirical+first-line+treatment+for+Helicobacter+pylori+eradication+in+Hong+Kong?en_HK
dc.identifier.emailHung, IFN: ivanhung@hkucc.hku.hken_HK
dc.identifier.emailSeto, WK: wkseto2@hku.hken_HK
dc.identifier.emailChu, KM: chukm@hkucc.hku.hken_HK
dc.identifier.emailWong, BCY: bcywong@hku.hken_HK
dc.identifier.authorityHung, IFN=rp00508en_HK
dc.identifier.authoritySeto, WK=rp01659en_HK
dc.identifier.authorityChu, KM=rp00435en_HK
dc.identifier.authorityWong, BCY=rp00429en_HK
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.1111/j.1523-5378.2009.00722.xen_HK
dc.identifier.pmid19889067en_HK
dc.identifier.scopuseid_2-s2.0-70449401522en_HK
dc.identifier.hkuros168257en_HK
dc.identifier.hkuros213679-
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-70449401522&selection=ref&src=s&origin=recordpageen_HK
dc.identifier.volume14en_HK
dc.identifier.issue6en_HK
dc.identifier.spage505en_HK
dc.identifier.epage511en_HK
dc.identifier.isiWOS:000272141700001-
dc.publisher.placeUnited Kingdomen_HK
dc.identifier.scopusauthoridHung, IFN=7006103457en_HK
dc.identifier.scopusauthoridChan, P=7403497841en_HK
dc.identifier.scopusauthoridLeung, S=36613279600en_HK
dc.identifier.scopusauthoridChan, FSY=35239825500en_HK
dc.identifier.scopusauthoridHsu, A=16204995400en_HK
dc.identifier.scopusauthoridBut, D=24343113400en_HK
dc.identifier.scopusauthoridSeto, WK=23390675900en_HK
dc.identifier.scopusauthoridWong, SY=7404590845en_HK
dc.identifier.scopusauthoridChan, CK=7404813960en_HK
dc.identifier.scopusauthoridGu, Q=24469982400en_HK
dc.identifier.scopusauthoridTong, TSM=7102587364en_HK
dc.identifier.scopusauthoridCheung, TK=7103334158en_HK
dc.identifier.scopusauthoridChu, KM=7402453538en_HK
dc.identifier.scopusauthoridWong, BCY=7402023340en_HK
dc.identifier.citeulike6234145-

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