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Predictors of failure of Helicobacter pylori eradication with the standard ‘Maastricht triple therapy’
- Source :
- Alimentary Pharmacology & Therapeutics. 15:1023-1029
- Publication Year :
- 2001
- Publisher :
- Wiley, 2001.
-
Abstract
- Background: Triple therapy with proton pump inhibitor, clarithromycin and amoxicillin has recently been proposed in Maastricht as first-line treatment for H. pylori infection. Aim: To determine predictors of unsuccessful eradication. Methods: Two hundred and forty-eight patients underwent endoscopy with biopsies for rapid urease test, histology and culture with antibiotic susceptibility tests, and 13C-UBT. All infected patients were given pantoprazole (40 mg b.d.), clarithromycin (500 mg b.d.) and amoxicillin (1 g b.d.) for 1 week. Eradication was assessed by UBT at 4–6 weeks after therapy. Results: One hundred and sixty-two of 248 patients (65%) were infected. Culture was positive in 144 (89%). Prevalence rates of metronidazole, clarithromycin and amoxicillin resistance were 14, 8 and 3%, respectively. Eradication rates (95% CI) were 63% (54.7–70.6) by intention-to-treat analysis and 67% (59.4–75.4) by per protocol analysis. Drug compliance was excellent and side-effects were mild. Age ≥ 45 years (OR: 2.35, CI: 1.30–4.25), smoking (OR: 1.37, CI 1.01–1.87) and high pre-treatment UBT results (OR: 1.36, CI: 1.08–1.72) were independent predictors of eradication failure. Gender, endoscopic findings, alcohol intake, and clarithromycin and amoxicillin resistance did not predict treatment failure. Conclusion: Despite the low prevalence of primary antibiotic resistance in our geographical area, triple therapy with pantoprazole, amoxicillin and clarithromycin achieves low eradication rates. Smoking, age and pre-treatment UBT results are predictors of potential eradication failure.
- Subjects :
- medicine.medical_specialty
Intention-to-treat analysis
Hepatology
biology
business.industry
Gastroenterology
Rapid urease test
Amoxicillin
Helicobacter pylori
biology.organism_classification
Surgery
Metronidazole
Clarithromycin
Internal medicine
medicine
Pharmacology (medical)
business
medicine.drug
Pantoprazole
Antibacterial agent
Subjects
Details
- ISSN :
- 02692813
- Volume :
- 15
- Database :
- OpenAIRE
- Journal :
- Alimentary Pharmacology & Therapeutics
- Accession number :
- edsair.doi...........cc971677b01988df55e9b6fcff1aae7f