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Influence of clarithromycin on the bactericidal effect of amoxicillin in patients infected with clarithromycin-resistant strains of H. pylori
- Source :
- Gut
- Publication Year :
- 2020
- Publisher :
- BMJ, 2020.
-
Abstract
- Objective To date, no randomised trials have compared the efficacy of vonoprazan and amoxicillin dual therapy with other standard regimens for Helicobacter pylori treatment. This study aimed to investigate the efficacy of the 7-day vonoprazan and low-dose amoxicillin dual therapy as a first-line H. pylori treatment, and compared this with vonoprazan-based triple therapy. Design This prospective, randomised clinical trial was performed at seven Japanese institutions. Patients with H. pylori–positive culture test and naive to treatment were randomly assigned in a 1:1 ratio to either VA-dual therapy (vonoprazan 20 mg+amoxicillin 750 mg twice/day) or VAC-triple therapy (vonoprazan 20 mg+amoxicillin 750 mg+clarithromycin 200 mg twice/day) for 7 days, with stratification by age, sex, H. pylori antimicrobial resistance and institution. Eradication success was evaluated by 13C-urea breath test at least 4 weeks after treatment. Results Between October 2018 and June 2019, 629 subjects were screened and 335 were randomised. The eradication rates of VA-dual and VAC-triple therapies were 84.5% and 89.2% (p=0.203) by intention-to-treat analysis, respectively, and 87.1% and 90.2% (p=0.372) by per-protocol analysis, respectively. VA-dual was non-inferior to VAC-triple in the per-protocol analysis. The eradication rates in strains resistant to clarithromycin for VA-dual were significantly higher than those for VAC-triple (92.3% vs 76.2%; p=0.048). The incidence of adverse events was equal between groups. Conclusion The 7-day vonoprazan and low-dose amoxicillin dual therapy provided acceptable H. pylori eradication rates and a similar effect to vonoprazan-based triple therapy in regions with high clarithromycin resistance. Trial registration number UMIN000034140.
- Subjects :
- 0301 basic medicine
medicine.medical_specialty
Vonoprazan
macromolecular substances
Drug resistance
antibiotics - clinical trials
Gastroenterology
03 medical and health sciences
0302 clinical medicine
Japan
Clarithromycin
Internal medicine
polycyclic compounds
medicine
Humans
Pyrroles
In patient
gastric inflammation
Sulfonamides
clinical trials
Helicobacter pylori
biology
business.industry
Amoxicillin
helicobacter pylori - treatment
clarithromycin-resistant
dual therapy
biochemical phenomena, metabolism, and nutrition
bacterial infections and mycoses
Bactericidal effect
biology.organism_classification
Anti-Bacterial Agents
030104 developmental biology
Gastric acid
030211 gastroenterology & hepatology
business
medicine.drug
Subjects
Details
- ISSN :
- 14683288 and 00175749
- Volume :
- 69
- Database :
- OpenAIRE
- Journal :
- Gut
- Accession number :
- edsair.doi.dedup.....763c9bbc36d771779f6cf8d45e0f3274