Which is better amoxycillin or tetracycline for h pylori?
Answers
The aim of this study was to evaluate the eradication rate of a triple therapy regimen that included a proton pump inhibitor, amoxicillin, and tetracycline instead of clarithromycin in treatment-Naïve patients and in patients who did not respond to standard triple therapy.
Methods
This study included 110 patients infected with Helicobacter pylori. Patients in groups A and B were treatment-Naïve, and those in group C were not responsive to previous standard triple therapy. Patients in group A (n=40) received lansoprazole 30 mg b.i.d., amoxicillin 1,000 mg b.i.d., and clarithromycin 500 mg b.i.d. for 14 days. Patients in groups B (n=40) and C (n=30) received lansoprazole 30 mg b.i.d., amoxicillin 1,000 mg b.i.d., and tetracycline 500 mg q.i.d. for 14 days.
Results
In group A, eradication was achieved in 18 (45%) of the 40 patients included in the intention-to-treat (ITT) analysis and in 18 (47.4%) of the 38 patients included in the per-protocol (PP) analysis. In group B, eradication was achieved in 15 (37.5%) of the 40 patients included in the ITT analysis and in 15 (39.3%) of the 38 patients included in the PP analysis. In group C, eradication was achieved in 14 (46.6%) of the 30 patients included in the ITT analysis and in 14 (43.8%) of the 29 patients included in the PP analysis. There was no statistically significant difference among the 3 groups with regard to eradication rates (p>0.05).
Conclusions
Despite the low rate of resistance to tetracycline, the combination of lansoprazole, amoxicillin, and tetracycline instead of clarithromycin is not a good option for the eradication of H. pylori.
Keywords: Helicobacter pylori, Tetracycline, Rescue therapy
INTRODUCTION
Helicobacter pylori is associated with chronic active gastritis, peptic ulcer, gastric adenocarcinoma, and mucosa-associated lymphoid tissue lymphoma.1-4 It was accepted as grade 1 carcinogen in 1994 by World Health Organization (WHO).5 While the prevalence of H. pylori frequency is decreasing in developed countries, it is increasing in developing countries.6 Although "test and treat" is an accepted approach in high prevalence locations such as Turkey, resistance to antibiotics is an important problem and eradication rate is decreasing worldwide.7 Clinically adequate regimens should provide H. pylori eradication in at 80% of patients, and should not cause any important adverse effect and clinically significant resistance to antibiotics. The most widely accepted standard triple therapy includes amoxicillin, clarithromycin and a proton pump inhibitor (PPI). However, eradication rates of this regimen are between 40% and 60%.8,9 Resistance to clarithromycin is considered to be the major reason for treatment failure. Tetracycline acts via impairing ribosome functions similar to clarithromycin.10 Since resistance develops to drug itself not to the action mechanism of the drug, we thought that tetracycline could be a good alternative in our country where the rate of resistance to clarithromycin is high. The aim of this study is to evaluate the eradication rate of triple therapy regimen including a PPI, amoxicillin, and tetracycline instead of clarithromycin both in treatment-naïve and those who did not respond to standard triple therapy.
MATERIALS AND METHODS
1. Patients
This prospective, randomized study included 80 treatment-naïve patients who presented to Haydarpaşa Numune Education and Research Hospital Gastroenterology Outpatient Clinic with H. pylori-positive nonulcer dyspepsia and 30 patients with H. pylori-positive nonulcer dyspepsia who previously did not respond to standard triple therapy for 14 days. The presence of H. pylori was assessed via histologic examination and rapid urease test (CLO® test) in treatment naive patients. During upper gastrointestinal endoscopy, two samples were taken from the gastric antrum for histologic assessment and rapid urease test. Patients were eligible for the study if both tests were positive for H. pylori. The presence of H. pylori was also assessed via the same methods in unresponsive patients prior to the previous therapy. Unresponsive patients were included into the study by confirming H. pylori-positivity with C14 urea breath test 4 to 6 weeks after completion of therapy.