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- Title
Clarithromycin-Resistant Genotypes and Eradication of Helicobacter pylori.
- Authors
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; Lerardi, Enzo
- Abstract
Background: Three point mutations (A2143G, A2142G, and A2142C) have been involved in Helicobacter pylon 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. Selling: Two hospitals in central and southern Italy between January and December 2001. Patients: 156 patients with H. pylon 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 pylon 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 sub-study 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.
- Subjects
HELICOBACTER pylori; GENETIC mutation; POLYMERASE chain reaction; HISTOLOGY; UREASE; PATIENTS
- Publication
Annals of Internal Medicine, 2006, Vol 144, Issue 2, p94
- ISSN
0003-4819
- Publication type
Article
- DOI
10.7326/0003-4819-144-2-200601170-00006