Abstract
Background: Three point mutations (A2143G, A2142G, and A2142C) have been involved in Helicobacter pylori clarithromycin resistance. Objective: To compare the eradication rates among the different point mutations and the efficacy of triple therapy and a sequential regimen according to genotypic resistance. Design: Post hoc subgroup study from a multicenter, randomized trial. Setting: Two hospitals in central and southern Italy between January and December 2001. Patients: 156 patients with H. pylori infection. Measurements: Real-time polymerase chain reaction for assessing clarithromycin resistance; histology, rapid urease test, and 13C-urea breath test at entry and after 4 to 6 weeks. Intervention: 7-day triple therapy (20 mg of rabeprazole, 500 mg of clarithromycin, and 1 g of amoxicillin) in 75 patients or a 10-day sequential regimen (20 mg of rabeprazole plus 1 g of amoxicillin for 5 days and 20 mg of rabeprazole, 500 mg of clarithromycin, and 500 mg of tinidazole for the remaining 5 days) in 81 patients. All drugs were given twice daily. Results: Helicobacter pylori infection was eradicated in 11 of 23 patients (48%) with the A2143G mutation and in 14 of 15 patients (93%) with either A2142G or A2142C strains (difference, 45 percentage points [95% CI, 15 to 65 percentage points]; P = 0.004). The sequential regimen achieved a higher cure rate than triple therapy in A2143G mutate strains (difference, 49 percentage points [CI, 8 to 72 percentage points]; P = 0.024). Limitations: The post hoc substudy design may require further confirmation. Other limitations are the accessibility to the tool and the cost of investigations (€70 per patient). Conclusions: The A2143G mutation seemed to be associated with a very low eradication rate. The sequential regimen achieved a higher cure rate than standard therapy even in patients with these strains.
| Original language | English |
|---|---|
| Pages (from-to) | 94-100 |
| Number of pages | 7 |
| Journal | Annals of Internal Medicine |
| Volume | 144 |
| Issue number | 2 |
| Publication status | Published - Jan 17 2006 |
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ASJC Scopus subject areas
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Clarithromycin-resistant genotypes and eradication of Helicobacter pylori. / De Francesco, Vincenzo; Margiotta, Marcella; Zullo, Angelo; Hassan, Cesare; Troiani, Laura; Burattini, Osvaldo; Stella, Francesca; Di Leo, Alfredo; Russo, Francesco; Marangi, Stefania; Monno, Rosa; Stoppino, Vincenzo; Morini, Sergio; Panella, Carmine; Ierardi, Enzo.
In: Annals of Internal Medicine, Vol. 144, No. 2, 17.01.2006, p. 94-100.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Clarithromycin-resistant genotypes and eradication of Helicobacter pylori
AU - De Francesco, Vincenzo
AU - Margiotta, Marcella
AU - Zullo, Angelo
AU - Hassan, Cesare
AU - Troiani, Laura
AU - Burattini, Osvaldo
AU - Stella, Francesca
AU - Di Leo, Alfredo
AU - Russo, Francesco
AU - Marangi, Stefania
AU - Monno, Rosa
AU - Stoppino, Vincenzo
AU - Morini, Sergio
AU - Panella, Carmine
AU - Ierardi, Enzo
PY - 2006/1/17
Y1 - 2006/1/17
N2 - Background: Three point mutations (A2143G, A2142G, and A2142C) have been involved in Helicobacter pylori clarithromycin resistance. Objective: To compare the eradication rates among the different point mutations and the efficacy of triple therapy and a sequential regimen according to genotypic resistance. Design: Post hoc subgroup study from a multicenter, randomized trial. Setting: Two hospitals in central and southern Italy between January and December 2001. Patients: 156 patients with H. pylori infection. Measurements: Real-time polymerase chain reaction for assessing clarithromycin resistance; histology, rapid urease test, and 13C-urea breath test at entry and after 4 to 6 weeks. Intervention: 7-day triple therapy (20 mg of rabeprazole, 500 mg of clarithromycin, and 1 g of amoxicillin) in 75 patients or a 10-day sequential regimen (20 mg of rabeprazole plus 1 g of amoxicillin for 5 days and 20 mg of rabeprazole, 500 mg of clarithromycin, and 500 mg of tinidazole for the remaining 5 days) in 81 patients. All drugs were given twice daily. Results: Helicobacter pylori infection was eradicated in 11 of 23 patients (48%) with the A2143G mutation and in 14 of 15 patients (93%) with either A2142G or A2142C strains (difference, 45 percentage points [95% CI, 15 to 65 percentage points]; P = 0.004). The sequential regimen achieved a higher cure rate than triple therapy in A2143G mutate strains (difference, 49 percentage points [CI, 8 to 72 percentage points]; P = 0.024). Limitations: The post hoc substudy design may require further confirmation. Other limitations are the accessibility to the tool and the cost of investigations (€70 per patient). Conclusions: The A2143G mutation seemed to be associated with a very low eradication rate. The sequential regimen achieved a higher cure rate than standard therapy even in patients with these strains.
AB - Background: Three point mutations (A2143G, A2142G, and A2142C) have been involved in Helicobacter pylori clarithromycin resistance. Objective: To compare the eradication rates among the different point mutations and the efficacy of triple therapy and a sequential regimen according to genotypic resistance. Design: Post hoc subgroup study from a multicenter, randomized trial. Setting: Two hospitals in central and southern Italy between January and December 2001. Patients: 156 patients with H. pylori infection. Measurements: Real-time polymerase chain reaction for assessing clarithromycin resistance; histology, rapid urease test, and 13C-urea breath test at entry and after 4 to 6 weeks. Intervention: 7-day triple therapy (20 mg of rabeprazole, 500 mg of clarithromycin, and 1 g of amoxicillin) in 75 patients or a 10-day sequential regimen (20 mg of rabeprazole plus 1 g of amoxicillin for 5 days and 20 mg of rabeprazole, 500 mg of clarithromycin, and 500 mg of tinidazole for the remaining 5 days) in 81 patients. All drugs were given twice daily. Results: Helicobacter pylori infection was eradicated in 11 of 23 patients (48%) with the A2143G mutation and in 14 of 15 patients (93%) with either A2142G or A2142C strains (difference, 45 percentage points [95% CI, 15 to 65 percentage points]; P = 0.004). The sequential regimen achieved a higher cure rate than triple therapy in A2143G mutate strains (difference, 49 percentage points [CI, 8 to 72 percentage points]; P = 0.024). Limitations: The post hoc substudy design may require further confirmation. Other limitations are the accessibility to the tool and the cost of investigations (€70 per patient). Conclusions: The A2143G mutation seemed to be associated with a very low eradication rate. The sequential regimen achieved a higher cure rate than standard therapy even in patients with these strains.
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M3 - Article
C2 - 16418408
AN - SCOPUS:33644798246
VL - 144
SP - 94
EP - 100
JO - Annals of Internal Medicine
JF - Annals of Internal Medicine
SN - 0003-4819
IS - 2
ER -