Eradication of Helicobacter pylori by a 1-week course of famotidine, amoxicillin and clarithromycin.
Objectives: The combination of a proton pump inhibitor (PPI) such as omeprazole with amoxicillin and clarithromycin constitutes one of the most effective treatments for the eradication of Helicobacter pylori. Nevertheless, the mechanisms of interaction between these drugs remain unclear. It has been...
| Publicado en: | European Journal of Gastroenterology & Hepatology Vol. 10; no. 7; pp. 579 - 583 |
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| Autores principales: | , , , , , , , , , |
| Formato: | clinical trial research Journal Article |
| Publicado: |
Lippincott Williams & Wilkins
Jul1998
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=110640786&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 110640786 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 0954691X 8CE jtl: European Journal of Gastroenterology & Hepatology issn: 0954691X maglogo: N pubinfo: dt: Jul1998 vid: 10 iid: 7 pid: 5086 pub: Lippincott Williams & Wilkins place: Baltimore, Maryland artinfo: ui: 110640786 110640786 NLM9855082 110640786 10.1097/00042737-199807000-00010 NLM9855082 110640786 ppf: 579 ppct: 4 formats: tig: atl: Eradication of Helicobacter pylori by a 1-week course of famotidine, amoxicillin and clarithromycin. aug: au: Gschwantler, Michael Dragosics, Brigitte Wurzer, Herbert Brandstätter, Gerald Weiss, Werner Gschwantler, M Dragosics, B Wurzer, H Brandstätter, G Weiss, W affil: 4th Department of Internal Medicine, KA Rudolfstiftung, Vienna, Austria; bAmbulatory Care Centre South, Regional Public Medical Insurance Agency, Vienna, Austria; and the c2nd Medical Department, General Hospital, Graz, Austria sug: subj: Histamine H2 Antagonists Therapeutic Use Helicobacter Pylori Helicobacter Infections Drug Therapy Famotidine Therapeutic Use Penicillins Therapeutic Use Amoxicillin Therapeutic Use Antibiotics Therapeutic Use Adult Drug Therapy, Combination Treatment Outcomes Aged Peptic Ulcer Microbiology Male Middle Age Human Pilot Studies Prospective Studies Female Antibiotics, Macrolide Duodenal Ulcer Drug Therapy Peptic Ulcer Drug Therapy Duodenal Ulcer Microbiology Clinical Trials Validation Studies Comparative Studies Evaluation Research Multicenter Studies Adult: 19-44 years Aged: 65+ years Middle Aged: 45-64 years Male Female ab: Objectives: The combination of a proton pump inhibitor (PPI) such as omeprazole with amoxicillin and clarithromycin constitutes one of the most effective treatments for the eradication of Helicobacter pylori. Nevertheless, the mechanisms of interaction between these drugs remain unclear. It has been shown that minimal inhibitory concentration values of both antibiotics are considerably lower at neutral pH levels than in an acid environment. Further, omeprazole possesses bacteriostatic activity. To evaluate the significance of these mechanisms we replaced omeprazole with famotidine, a drug which only suppresses acid production, but has no intrinsic antimicrobial activity.Methods: We evaluated the efficacy of a 1-week course of famotidine 80 mg b.i.d., amoxicillin 1000 mg b.i.d. and clarithromycin 500 mg b.i.d. in a pilot study (20 patients), and then confirmed our results in a larger replication study (87 patients). A total of 107 patients with H. pylori-associated duodenal ulcer (n = 54), gastric ulcer (n = 14) or non-ulcer dyspepsia (n = 39) were included. Endoscopy was performed at baseline and 4-6 weeks after discontinuation of treatment. H. pylori status was assessed by the urease test and histology.Results: H. pylori was successfully eradicated in 94 of 104 patients who completed the study (90.4%; CI 95%, 83.0-95.3%). By intention-to-treat analysis, the eradication rate was 87.9% (CI 95%, 80.1-93.4%). Ulcer healing was observed in 98.1% of duodenal ulcers and 92.9% of gastric ulcers (based on per-protocol analysis). Mild side effects that did not require termination of treatment were reported by seven patients (6.7%).Conclusion: A 1-week course of famotidine, amoxicillin and clarithromycin is a highly effective, simple and safe eradication regimen. Our data indicate that acid suppression is the crucial mechanism by which the activity of amoxicillin and clarithromycin against H. pylori is enhanced, whereas additional antimicrobial activity or other specific effects of PPIs seem to be less important. pubtype: Academic Journal doctype: clinical trial research Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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