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Clarithromycin Versus Metronidazole as First-line Helicobacter pylori Eradication: A Multicenter, Prospective, Randomized Controlled Study in Japan.
- Source :
-
Journal of clinical gastroenterology [J Clin Gastroenterol] 2015 Jul; Vol. 49 (6), pp. 468-71. - Publication Year :
- 2015
-
Abstract
- Background: Helicobacter pylori eradication rates achieved with a first-line regimen of clarithromycin (CLR) combined with amoxicillin (AMX) and a proton pump inhibitor have recently fallen to ≤80% because of the increasing incidence of CLR resistance in Japan. This randomized multicenter trial aimed to compare the eradication success of 2 first-line triple therapy regimens: rabeprazole, amoxicillin, and clarithromycin (RAC) versus rabeprazole, amoxicillin, and metronidazole (RAM).<br />Methods: A total of 124 consecutive patients infected with H. pylori were randomized into one of two 7-day therapeutic regimens: RAC (n=60) or RAM (n=64). Eradication was confirmed by the C-urea breath test. Adverse effects were also assessed.<br />Results: Intention-to-treat and per protocol H. pylori eradication rates were 73.3%/77.2% in the RAC group and 90.6%/93.5% in the RAM group. The eradication rate of RAM therapy was significantly higher than that of RAC therapy. CLR, metronidazole, and AMX resistance was found in 36.2%, 2.1%, and 0% of patients, respectively. In addition, no relevant differences in adverse effects were observed.<br />Conclusions: Metronidazole-based therapy (RAM) was superior to standard CLR-based therapy (RAC) for first-line H. pylori eradication. This reflects the progressive increase in CLR resistance observed in Japan.
- Subjects :
- Aged
Amoxicillin therapeutic use
Anti-Ulcer Agents therapeutic use
Breath Tests
Drug Resistance, Bacterial drug effects
Drug Therapy, Combination
Female
Humans
Japan
Male
Middle Aged
Prospective Studies
Rabeprazole therapeutic use
Urea
Anti-Infective Agents therapeutic use
Clarithromycin therapeutic use
Helicobacter Infections drug therapy
Helicobacter pylori drug effects
Metronidazole therapeutic use
Subjects
Details
- Language :
- English
- ISSN :
- 1539-2031
- Volume :
- 49
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- Journal of clinical gastroenterology
- Publication Type :
- Academic Journal
- Accession number :
- 24921211
- Full Text :
- https://doi.org/10.1097/MCG.0000000000000165