Influence of 1-week Helicobacter pylori eradication therapy with rabeprazole, clarithromycin, and metronidazole on 13C-aminopyrine breath test

Helicobacter pylori eradication therapy is commonly prescribed in the general population. Treatment consists of drugs that are mainly metabolized by the liver cytochrome P-450 (CYP) enzymatic pool. Most H. pylori-infected patients often take drugs for comorbid illnesses, therefore increasing the potential for drug-drug interactions. We aimed to evaluate the interactions of rabeprazole, clarithromycin, and metronidazole 1-week H. pylori eradication therapy with CYP-dependent liver metabolic function in clinical practice. Ten patients referred to our unit for H. pylori infection underwent 1-week eradication therapy with rabeprazole (20 mg, b.i.d.), clarithromycin (500 mg, b.i.d.), and metronidazole (500 mg, b.i.d.). We chose the ¹³C- aminopyrine breath test (¹³C-ABT) to evaluate CYP-dependent liver function since it is noninvasive and nonharmful. All patients underwent ¹³C-ABT at three time points: before therapy (t₀), at the end of therapy (t₈), and after 1 month of follow-up (t₃₈). Mean ¹³C-ABT dose/hr (t₀ = 14.0 ± 5.4, t ₈ = 13.5 ± 4.0, t₃₈ = 16.1 ± 5.6) as well as ¹³C-ABT cumulative dose (t₀ = 2.4 ± 1.1, t ₈ = 2.4 ± 0.8, t₃₈ = 2.6 ± 1.0) were not statistically different at the three time points of the study. These results did not seem to be influenced by drugs being administered concomitantly. In everyday clinical practice rabeprazole-based H. pylori eradication therapy does not seem to display any significant interactions with CYP-dependent liver function, even in patients on multiple drugs.