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Cho SH, Park MS, Park SY, Kim DH, You HS, Kim HS. Effectiveness of 7-day triple therapy with half-dose clarithromycin for the eradication of Helicobacter pylori without the A2143G and A2142G point mutations of the 23S rRNA gene in a high clarithromycin resistance area. Front Med (Lausanne) 2023; 10:1150396. [PMID: 37035320 PMCID: PMC10073449 DOI: 10.3389/fmed.2023.1150396] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 02/27/2023] [Indexed: 04/11/2023] Open
Abstract
Background Tailored therapy has been widely used for patients with Helicobacter pylori (H. pylori) infection in South Korea. Herein, we evaluated the treatment outcomes of tailored clarithromycin-based triple therapy (TT) in patients infected with H. pylori. Methods We enrolled 460 patients without A2142G and A2143G point mutations by dual priming oligonucleotide-based polymerase chain reaction who had taken TT and undergone the urease breath test to evaluate eradication in clinical practice. Eradication rates according to the treatment duration and dose of clarithromycin were analyzed. Results Among 460 patients (164 women, median age 63.0 years), 250 patients underwent TT with full-dose clarithromycin (TT-full CLA), and 216 patients underwent TT with half-dose clarithromycin (TT-half CLA). The eradication rates were 88.0% (220/250) in patients with TT-full CLA and 85.2% (179/210) in patients with TT-half CLA. In 250 patients with TT-full CLA, the eradication rates were 86.8% (33/38) in patients with 7-day TT-full CLA and 88.2% (187/212) in patients with 10-day or 14-day TT-full CLA (P = 0.788). In 210 patients with TT-half CLA, the eradication rates were 84.2% (139/165) in those with a 7-day TT-half CLA and 88.9% (40/45) in those with a 10-day or 14-day TT-half CLA (P = 0.436). Conclusion For patients with H. pylori infection without A2142G and A2143G point mutations by DPO-PCR in clinical practice, treatment extension above 7-day TT with full CLA did not improve the eradication rates. Future studies on the treatment outcomes of TT-half CLA considering effectiveness and compliance are warranted.
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Affiliation(s)
- Seong Hyun Cho
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Moon Sik Park
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Seon-Young Park
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Dong Hyun Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Hye-Su You
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Hyun-Soo Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
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Nyssen OP, Perez-Aisa A, Tepes B, Castro-Fernandez M, Kupcinskas J, Jonaitis L, Bujanda L, Lucendo A, Jurecic NB, Perez-Lasala J, Shvets O, Fadeenko G, Huguet JM, Kikec Z, Bordin D, Voynovan I, Leja M, Machado JC, Areia M, Fernandez-Salazar L, Rodrigo L, Alekseenko S, Barrio J, Ortuño J, Perona M, Vologzhanina L, Romero PM, Zaytsev O, Rokkas T, Georgopoulos S, Pellicano R, Buzas GM, Modolell I, Gomez Rodriguez BJ, Simsek I, Simsek C, Lafuente MR, Ilchishina T, Camarero JG, Dominguez-Cajal M, Ntouli V, Dekhnich NN, Phull P, Nuñez O, Lerang F, Venerito M, Heluwaert F, Tonkic A, Caldas M, Puig I, Megraud F, O'Morain C, Gisbert JP. Adverse Event Profile During the Treatment of Helicobacter pylori: A Real-World Experience of 22,000 Patients From the European Registry on H. pylori Management (Hp-EuReg). Am J Gastroenterol 2021; 116:1220-1229. [PMID: 33840725 DOI: 10.14309/ajg.0000000000001246] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 02/23/2021] [Indexed: 12/11/2022]
Abstract
INTRODUCTION The safety of Helicobacter pylori eradication treatments and to what extent adverse events (AEs) influence therapeutic compliance in clinical practice are hardly known. Our aim was to assess the frequency, type, intensity, and duration of AEs, and their impact on compliance, for the most frequently used treatments in the "European Registry on Helicobacter pylori management." METHODS Systematic prospective noninterventional registry of the clinical practice of European gastroenterologists (27 countries, 300 investigators) on the management of H. pylori infection in routine clinical practice. All prescribed eradication treatments and their corresponding safety profile were recorded. AEs were classified depending on the intensity of symptoms as mild/moderate/severe and as serious AEs. All data were subject to quality control. RESULTS The different treatments prescribed to 22,492 patients caused at least 1 AE in 23% of the cases; the classic bismuth-based quadruple therapy was the worst tolerated (37% of AEs). Taste disturbance (7%), diarrhea (7%), nausea (6%), and abdominal pain (3%) were the most frequent AEs. The majority of AEs were mild (57%), 6% were severe, and only 0.08% were serious, with an average duration of 7 days. The treatment compliance rate was 97%. Only 1.3% of the patients discontinued treatment due to AEs. Longer treatment durations were significantly associated with a higher incidence of AEs in standard triple, concomitant, bismuth quadruple, and levofloxacin triple or quadruple therapies. DISCUSSION Helicobacter pylori eradication treatment frequently induces AEs, although they are usually mild and of limited duration. Their appearance does not interfere significantly with treatment compliance.
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Affiliation(s)
- Olga P Nyssen
- Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | - Angeles Perez-Aisa
- Gastroenterology Unit, Agencia Sanitaria Costa del Sol, Marbella, Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Málaga, Spain
| | - Bojan Tepes
- Gastroenterology Unit, AM DC Rogaska, Rogaska Slatina, Slovenia
| | | | - Juozas Kupcinskas
- Gastroenterology Unit, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Laimas Jonaitis
- Gastroenterology Unit, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Luis Bujanda
- Gastroenterology Unit, Hospital Donostia/Instituto Biodonostia, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Universidad del País Vasco (UPV/EHU), San Sebastián, Spain
| | - Alfredo Lucendo
- Gastroenterology Unit, Hospital de Tomelloso, Ciudad Real, Spain
| | | | | | - Oleg Shvets
- Gastroenterology Unit, Internal Diseases Department No. 1, National Medical University named after O.O. Bogomolets, Kyiv, Ukraine
| | - Galina Fadeenko
- Gastroenterology Unit, National Ukrainian Academy of Medical Sciences, Ukraine
| | - Jose M Huguet
- Gastroenterology Unit, Consorci Hospital General Universitari Valencia, Spain
| | - Zdenki Kikec
- Gastroenterology Unit, Hospital Slovenj Gradec, Slovenj Gradec, Slovenia
| | - Dmitry Bordin
- Gastroenterology Unit, A. S. Loginov Moscow Clinical Scientific Center, Moscow, Russia
- Gastroenterology Unit, Department of Outpatient Therapy and Family Medicine, Tver State Medical University, Tver, Russia
- Gastroenterology Unit, Department of Propaedeutic of Internal diseases and Gastroenterology, A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - Irina Voynovan
- Gastroenterology Unit, A. S. Loginov Moscow Clinical Scientific Center, Moscow, Russia
| | - Marcis Leja
- Gastroenterology Unit, Digestive Diseases Center GASTRO, Riga, Latvia
| | - Jose Carlos Machado
- Gastroenterology Unit, Instituto de Investigação e Inovação em Saúde, Universidade do Porto, and Ipatimup-Institute of Molecular Pathology and Immunology of the University of Porto, Portugal
| | - Miguel Areia
- Gastroenterology Unit, Portuguese Oncology Institute of Coimbra, Portugal
| | | | - Luis Rodrigo
- Gastroenterology Unit, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Sergey Alekseenko
- Gastroenterology Unit, Far Eastern State Medical University Khabarovsk, Russia
| | - Jesus Barrio
- Gastroenterology Unit, Hospital Rio Hortega, Valladolid, Spain
| | - Juan Ortuño
- Gastroenterology Unit, Hospital Universitari I Politècnic La Fe Valencia, Spain
| | - Monica Perona
- Gastroenterology Unit, Hospital Quiron Marbella, Spain
| | | | - Pilar Mata Romero
- Gastroenterology Unit, Hospital San Pedro de Alcántara, Cáceres, Spain
| | - Oleg Zaytsev
- Gastroenterology Unit, First Clinical Medical Center Kovrov, Russia
| | - Theodore Rokkas
- Gastroenterology Unit, Henry Dunant Hospital, Athens, Greece
| | - Sotirios Georgopoulos
- Gastroenterology Unit, Athens Medical Center, Paleo Faliron General Hospital Athens, Greece
| | | | - Gyorgy M Buzas
- Gastroenterology Unit, Ferencváros Policlinic, Budapest, Hungary
| | - Ines Modolell
- Gastroenterology Unit, Consorci Sanitari Terrassa, Spain
| | | | - Ilkay Simsek
- Gastroenterology Unit, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Cem Simsek
- Gastroenterology Unit, Hacettepe University Ankara, Turkey
| | | | | | | | | | | | | | - Perminder Phull
- Gastroenterology Unit, Aberdeen Royal Infirmary Aberdeen, United Kingdom
| | - Oscar Nuñez
- Gastroenterology Unit, Hospital Universitario Sanitas La Moraleja, Madrid, Spain
| | - Frode Lerang
- Gastroenterology Unit, Medical Department, Central Hospital Ostfold, Fredrikstad, Norway
| | - Marino Venerito
- Gastroenterology Unit, Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University Hospital, Magdeburg, Germany
| | - Frederic Heluwaert
- Gastroenterology Unit, Center Hospitalier Annecy Genvois, Pringy, France
| | - Ante Tonkic
- Gastroenterology Unit, University Hospital of Split, School of Medicine, University of Split, Croatia
| | - Maria Caldas
- Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | - Ignasi Puig
- Gastroenterology Unit, Althaia Xarxa Assistencial Universitària de Manresa and Universitat de Vic-Universitat Central de Catalunya (UVicUCC), Manresa, Spain
| | - Francis Megraud
- Gastroenterology Unit, Laboratoire de Bactériologie, Hôpital Pellegrin, Bordeaux, France
| | - Colm O'Morain
- Gastroenterology Unit, Department of Clinical Medicine, Trinity College Dublin, Ireland
| | - Javier P Gisbert
- Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
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Kim BJ, Yang C, Song HJ, Jeon SW, Kim GH, Kim H, Kim TH, Shim K, Chung I, Park MI, Choi IJ, Kim JH, Kim B, Baik GH, Han SW, Seo HE, Jung WT, Hwan Oh J, Kim SG, Lee JH, Park SK, Park B, Yang BR, Lee J, Kim JG. Online registry for nationwide database of Helicobacter pylori eradication in Korea: Correlation of antibiotic use density with eradication success. Helicobacter 2019; 24:e12646. [PMID: 31368629 PMCID: PMC6790945 DOI: 10.1111/hel.12646] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 06/18/2019] [Accepted: 06/26/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND The Helicobacter pylori eradication rate has decreased with increasing antibiotic resistance. We conducted a prospective, nationwide, multicenter registry study to monitor the real status of H. pylori eradication therapy and to investigate the association between eradication success and antibiotic use density in Korea. MATERIALS AND METHODS We enrolled 9318 patients undergoing H. pylori eradication therapy from 37 hospitals through "on-line database registry" from October 2010 to July 2015. Demographic data, detection methods, treatment indications, regimens, durations, compliance, adverse events, and eradication results were collected. The use of all commercially available eradication antibiotics was analyzed through the Korean National Health Insurance data of the Health Insurance Review and Assessment Service. The defined daily dose of antibiotics was used to standardize drug use comparisons. RESULTS Finally, 6738 patients were analyzed. The overall eradication rate of first-line therapy was 71.8%. The eradication success rates were 71.7%, 86.9%, and 74.0% for standard triple therapy for 7 days, quadruple therapy, and concomitant therapy, respectively. The eradication success rate in naive patients was higher than that in those who previously underwent H. pylori eradication. Eradication success was significantly associated with younger age, female sex, and high compliance. Regional differences in eradication rates were observed. The yearly use density of clarithromycin increased statistically in seven regions across the country from 2010 to 2015. The yearly use density of amoxicillin in the Gyeongsang and Chungcheong areas was significantly increased (P < .01), whereas that of other macrolides was significantly lower in the Gyeonggi area than in other areas (P = .01). The overall use of eradication antibiotics has increased while the eradication rate steadily decreased for 5 years. However, there was no significant correlation between antibiotic use density and eradication. CONCLUSION There was no relationship between the eradication rate and antibiotic use density in Korea.
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Affiliation(s)
- Beom Jin Kim
- Department of Internal MedicineChung‐Ang University College of MedicineSeoulKorea
| | - Chang‐Hun Yang
- Department of Internal MedicineDongguk University College of Medicine Gyeongju HospitalGyeongjuKorea
| | - Hyun Joo Song
- Department of Internal MedicineJeju National University School of MedicineJejuKorea
| | - Seong Woo Jeon
- Department of Internal Medicine, School of MedicineKyungpook National UniversityDaeguKorea
| | - Gwang Ha Kim
- Department of Internal MedicinePusan National University School of MedicineBusanKorea
| | - Hyun‐Soo Kim
- Department of Internal MedicineChonnam National University Medical SchoolGwangjuKorea
| | - Tae Ho Kim
- Department of Gastroenterology, Bucheon St. Mary’s Hospital, College of MedicineThe Catholic University of KoreaBucheonKorea
| | - Ki‐Nam Shim
- Department of Internal MedicineEwha Womans University School of MedicineSeoulKorea
| | - Il‐Kwun Chung
- Department of Internal Medicine, Cheonan HospitalSoon Chun Hyang University College of MedicineCheonanKorea
| | - Moo In Park
- Department of Internal Medicine, Kosin University Gospel HospitalKosin University College of MedicineBusanKorea
| | - Il Ju Choi
- Center for Gastric CancerNational Cancer CenterGyeonggiKorea
| | - Ji Hyun Kim
- Department of Internal MedicinePusan Paik Hospital, Inje University College of MedicineBusanKorea
| | - Byung‐Wook Kim
- Department of Internal Medicine, College of MedicineThe Catholic University of KoreaIncheonKorea
| | - Gwang Ho Baik
- Department of Internal MedicineHallym University College of MedicineSeoulKorea
| | - Sok Won Han
- Department of Gastroenterology, Bucheon St. Mary’s Hospital, College of MedicineThe Catholic University of KoreaBucheonKorea
| | - Hyang Eun Seo
- Department of Internal MedicineDaegu Fatima HospitalDaeguKorea
| | - Woon Tae Jung
- Department of Internal MedicineGyeongsang National University School of MedicineJinjuKorea
| | - Jung Hwan Oh
- Department of Internal Medicine, St. Paul's Hospital, College of MedicineThe Catholic University of KoreaSeoulKorea
| | - Sang Gyun Kim
- Department of Internal Medicine and Liver Research InstituteSeoul National University College of MedicineSeoulKorea
| | - Jun Haeng Lee
- Department of Medicine, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulKorea
| | - Sue K. Park
- Department of Preventive MedicineSeoul National University College of MedicineSeoulKorea,Department of Biomedical ScienceSeoul National University Graduate SchoolSeoulKorea,Cancer Research InstituteSeoul National UniversitySeoulKorea
| | - Byung‐Joo Park
- Department of Preventive MedicineSeoul National University College of MedicineSeoulKorea
| | - Bo Ram Yang
- Department of Biomedical ScienceSeoul National University Graduate SchoolSeoulKorea
| | - Joongyub Lee
- Department of Prevention and Management, Inha University Hospital, School of MedicineInha UniversityIncheonKorea
| | - Jae G. Kim
- Department of Internal MedicineChung‐Ang University College of MedicineSeoulKorea
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Lu B, Wang J, Li J, Liu L, Chen Y. Half-dose clarithromycin-containing bismuth quadruple therapy is effective and economical in treating Helicobacter pylori infection: A single-center, open-label, randomized trial. Helicobacter 2019; 24:e12566. [PMID: 30780194 DOI: 10.1111/hel.12566] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 12/22/2018] [Accepted: 12/26/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Clarithromycin-containing bismuth quadruple therapy has been recommended as the first-line therapy for H pylori infection in China. However, its expensive cost and high antibiotic-related adverse reactions are always haunting us. To find a safer, more cost-effective, and high eradicative strategy for Helicobacter treatment, we investigated the efficacy of 14-day bismuth quadruple therapy and different doses of clarithromycin in the first-line treatment. METHOD A total of 210 patients with H pylori infection were recruited and randomly assigned to half-dose clarithromycin group (esomeprazole 20 mg bid, amoxicillin 1 g bid, clarithromycin 250 mg bid, and bismuth potassium citrate 0.6 g bid) for 14 days or standard-dose clarithromycin group (esomeprazole 20 mg bid, amoxicillin 1 g bid, clarithromycin 500 mg bid, and bismuth potassium citrate 0.6 g bid) for 14 days. A 13 C-urea breath test (13 C-UBT) was performed at least 4 weeks after treatment. The eradication rate of H pylori, the incidence of side effects, and the cost-effectiveness of regimens were evaluated in this study. RESULTS The eradication frequencies were 86.67% for both groups in the intention-to-treat analysis, while the per-protocol eradication rates were 91% vs. 91.92% (p=0.817). The incidence of adverse events was higher in standard dose group (54.21% vs. 34.29%; p=0.004), especially bitter taste symptom. There was a higher level of costs per person associated with the standard-dose group as compared with half-dose group (¥804.3 vs ¥654.36). The cost-effectiveness ratio of the half dose was less than that of the standard dose (7.55 vs 9.16 CNY per percent). CONCLUSIONS A 14-day half-dose clarithromycin-containing bismuth quadruple regimen is as effective as the standard bismuth quadruple therapy at eradicating H pylori, which is better tolerated and more economical. (ChiCTR-ROC-15007406).
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Affiliation(s)
- Bingyun Lu
- Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jiamin Wang
- Department of Gastroenterology, University of Chinese Academy of Sciences Shenzhen Hospital, Shenzhen, China
| | - Jing Li
- Department of Gastroenterology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Le Liu
- Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Ye Chen
- Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China
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