Estudio aleatorizado comparando una primera línea de terapia estándar contra Helicobacter pylori con claritromicina versus levofloxacina por 10 días / Randomized study comparing standard first line 10 day therapy against Helicobacter pylori including clarithromycin versus standard first line therapy with levofloxacin

Antecedentes: Hay una creciente evidencia de que la terapia triple estándar contra la infección por H. pylori viene perdiendo efectividad clínica. Una terapia triple con levofloxacina, amoxicilina y un inhibidor de la bomba de protones es efectiva y bien tolerada, e incluso este régimen se ha sugerido como una alternativa para la terapia de primera línea. El propósito de este estudio aleatorizado, multicéntrico y controlado es comparar el éxito en la erradicación de dos líneas de terapia triples como son la claritromicina, amoxicilina y omeprazol (CAO) versus levofloxacina, amoxicilina y omeprazol (LAO). Materiales y métodos: Un total de 317 pacientes con diagnóstico por biopsia de infección por H. pylori fueron aleatorizados a dos regímenes de terapia por 10 días: terapia estándar CAO (n= 160) o LAO (n= 157). La erradicación fue evaluada por la prueba de aliento optimizada. Los efectos adversos y la tolerancia también fueron evaluados. Resultados: El análisispor intención de tratar fue: CAO, 68,8% (110/160) y LAO, 84,1% (132/157) p= 0,0021. Por protocolo las tasas de erradicación fueron: CAO, 71,9% (105/146) y LAO, 89,3% (125/140) P=0,0004. Hubo diferencias estadísticas en la efectividad entre los dos grupos de tratamiento. Además, no hubo diferencias en la tolerancia y losefectos adversos entre los dos grupos. Conclusiones: El tratamiento con una terapia estándar con base enlevofloxacina para la infección por H. pylori es una mejor alternativa para la erradicación del H. pylori sobre latriple terapia basada en claritromicina en el presente estudio

Background: Evidence is mounting that the standard triple therapy against H. pylori infections has beenlosing clinical effectiveness, but triple therapy with levofloxacin, amoxicillin, and a proton pump inhibitor iseffective and well tolerated. This scheme has been suggested as an alternative for standard first-line therapy.The purpose of this randomized, multicenter, controlled study is to compare rates of successful eradicationof standard triple therapy using clarithromycin, amoxicillin and omeprazole (CAO) and triple therapy usinglevofloxacin, amoxicillin and omeprazole (LAO). Materials and Methods: A total of 317 patients who hadbeen diagnosed with H. pylori infections through biopsies were randomized into two groups. One group of 160patients was assigned a 10 day CAO treatment regimen and the other group of 157 patients was assigneda 10 day LAO treatment regimen. Eradication was assessed by optimized breath test. Adverse effects andtoleration were also assessed. Results: Intention to treat analysis gave the following results: CAO, 68.8%(110/160) and LAO, 84.1% (132/157) with p = 0.0021. The CAO eradication rates was 71.9% (105/146) andthe LAO eradication rate was 89.3% (125/140) with p = 0.0004. There were significant statistical differencesin effectiveness between the two treatment groups, but there were no significant differences in toleration andadverse effects between the two groups. Conclusions: Treatment of H. pylori infections with triple therapybased on levofloxacin was a better alternative than clarithromycin-based triple therapy in this study

Effectiveness of intravenous clarithromycin followed by oral clarithromycin in acute exacerbation of asthma with respiratory tract infection.

In addition to its antimicrobial activity, macrolides have an immunomodulatory effect that may be beneficial to patients with asthma. This quasi-experimental study aimed to determine the effect of intravenous clarithromycin followed by oral administration in 37 patients with acute exacerbations asthma caused by respiratory tract infection during January - December 2005. Patients with mild to moderate exacerbations of asthma with respiratory tract infection meeting the inclusion and exclusion criteria were given intravenous clarithromycin 2 x 500 mg/day for not more than 5 days and followed by oral clarithromycin 2 x 500 mg/day for 7 days. Outcome variables were improvement of clinical symptoms according to the asthma exacerbation score and peak expiratory flow rate (PEFR). After 10 days, treatment resulted significant improvement in total asthma exacerbation score and morning PEFR in 35 patients enrolled this project. Based on clinical improvement and laboratory findings, the number of days required for intravenous clarithromycin was less then 3 days for 21 subjects, 3-5 days in 14 subjects. The most common causative pathogens were S. β-haemolyticus and Streptococcus sp. It was concluded that clarithromycin improved clinical symptoms and PEFR in exacerbation of asthma caused by respiratory tract infection.