Efficacy of serology driven 'test and treat strategy' for eradication of H. pylori in patients with rheumatic disease in the Netherlands.

de Leest, H. T. J. I.; Steen, K. S. S.; Lems, W. F.; van de Laar, M. A. F. J.; Huisman, A. M.; Kadir, S. W.; Houben, H. H. M.; Kostense, P. J.; Kuipers, E. J.; Dijkmans, B. A. C.; Debets-Ossenkopp, Y. J.

The treatment of choice of H. pylori infections is a 7-day triple-therapy with a proton pump inhibitor (PPI) plus amoxicillin and either clarithromycin or metronidazole, depending on local antibiotic resistance rates. The data on efficacy of eradication therapy in a group of rheumatology patients on long-term NSAID therapy are reported here. This study was part of a nationwide, multicenter RCT that took place in 2000-2002 in the Netherlands. Patients who tested positive for H. pylori IgG antibodies were included and randomly assigned to either eradication PPI-triple therapy or placebo. After completion, follow-up at 3 months was done by endoscopy and biopsies were sent for culture and histology. In the eradication group 13% (20/152, 95% CI 9-20%) and in the placebo group 79% (123/155, 95% CI 72-85%) of the patients were H. pylori positive by histology or culture. H. pylori was successfully eradicated in 91% of the patients who were fully compliant to therapy, compared to 50% of those who were not (difference of 41%; 95% CI 18-63%). Resistance percentages found in isolates of the placebo group were: 4% to clarithromycin, 19% to metronidazole, 1% to amoxicillin and 2% to tetracycline.

NETHERLANDS; HELICOBACTER pylori; ANTIBODY titer; RHEUMATISM; PROTON pump inhibitors; ENDOSCOPY; AMOXICILLIN; METRONIDAZOLE; PATIENTS; THERAPEUTICS

European Journal of Clinical Microbiology & Infectious Diseases, 2011, Vol 30, Issue 7, p903

0934-9723

Academic Journal

10.1007/s10096-011-1174-5