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Objective:To evaluate the impact of amoxicillin and clarithromycin resistance on the eradication rate of Helicobacter pylori ( H. pylori), and to explore the optimal minimal inhibitory concentration (MIC) breakpoint of amoxicillin and clarithromycin. Methods:From March 2008 to December 2010, patients with H. pylori positive received standard triple therapy to eradicate H. pylori were retrospectively analyzed, 140 patients with H. pylori infetion were included, of which 12 patients did not receive eradication treatment. At 8 to 12 weeks after treatment, the eradication rate of H. pylori of 140 and 128 patients was calculated by intention-to-treat (ITT) and per-protocol population (PP) analysis, respectively. The correlation between amoxicillin and clarithromycin resistance and failure of H. pylori eradication was analyzed. And the relation between different MIC breakpoints of amoxicillin and clarithromycin and failure of H. pylori eradication was also analyzed. Binary logistic regression analysis and consistency test were used for statistical analysis. Results:The results of ITT and PP analysis indicated that the eradication rate of H. pylori of the standard triple therapy was 66.4%(93/140)and 72.7% (93/128), respectively, 95% confidence interval ( CI) 59.3% to 74.3%, and 65.6% to 79.7%, respectively. The results of binary logistic regression analysis showed that amoxicillin resistance (odds ratio ( OR)=6.326, 95% CI 1.090 to 36.725, P=0.040) and clarithromycin resistance ( OR=10.686, 95% CI 4.031 to 28.326, P<0.01) were both independent risk factors of H. pylori eradication failure. The results of consistency test demonstrated that when the MIC breakpoint of amoxicillin was 0.125 mg/L, the correlation between amoxicillin resistance and H. pylori eradication failure was the highest (fair consistency, P<0.05); when the MIC breakpoint of clarithromycin was 2.000 mg/L, the correlation between clarithromycin resistance and H. pylori eradication failure was the highest (moderate consistency, P<0.05). Conclusions:The eradication rate of H. pylori of standard triple therapy dropped to <80%. The decrease of H. pylori eradication rate was related to the resistance of amoxicillin and clarithromycin. The best MIC breakpoints of amoxicillin and clarithromycin were 0.125 and 2.000 mg/L, respectively.
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Background: Integrative traditional Chinese and western medicine may be a new approach to improve the eradication rate of Helicobacter pylori (Hp).Aims: To compare the efficacy and safety of Weifuchun tablet versus bismuth combined with standard triple regimen as the first-line therapy of Hp infection.Methods: A total of 141 patients with Hp infection and na(i)ve to treatment were randomly assigned into 3 groups receiving a 14-day eradication therapy.In standard triple therapy group, esomeprazole, amoxicillin and clarithromycin were given twice a day;while in Weifuchun group and bismuth group, Weifuchun tablet and bismuth potassium citrate were added, respectively, to the standard triple therapy.Hp eradication was assessed by 13C-urea breath test at least 6 weeks after the end of treatment.Hp isolates were tested for resistance to antibiotics.Results: One hundred and twenty-eight patients completed the study.Hp eradication rates in Weifuchun group, bismuth group and standard triple therapy group were 83.7%, 91.8% and 79.1%, respectively by ITT analysis and 88.4%, 97.8% and 84.6%, respectively by PP analysis.The eradication rate of Weifuchun group was lower than that of bismuth group and higher than that of standard triple therapy group, but the differences were not statistically significant (P>0.05).Only PP eradication rate of bismuth group was significantly higher than that of standard triple therapy group (P0.05).Conclusions: Weifuchun tablet combined with standard triple regimen is safe and effective for use as first-line treatment for Hp infection, however, the eradication rate is relatively low in cases infected with clarithromycin resistant strains.Bismuth combined with standard triple regimen is a good alternative in areas with high clarithromycin resistance and regions where tetracycline is unavailable.
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Objective To observe the efficacy ofHuayu Kangyou Formula combined with Western medicine for Hp-related peptic ulcer disease;To discuss the mechanism of action.Methods Totally 152 patients were randomly divided into treatment group and control group, 76 cases in each group. Control group was given standard triple therapy, while treatment group was givenHuayu Kangyou Formula based on the standard triple therapy. The treatment lasted for 6 weeks. The clincal symptom scores and gastroscopy were observed to evaluate the therapeutic effect, adverse reactions were recorded, and relapse of ulcer was followed-up.Results The total effective rates of clinical symptoms in the treatment group and the control group were 94.74% (72/76) and 84.21% (64/76), respectively;the excellent rates were 78.95% (60/76) and 55.26% (42/76), respectively;the incidences of adverse reactions were 5.26% (4/76) and 13.16% (10/76), respectively;the relapse rates after 1 year of follow-up visit were 13.63% (6/44) and 41.67% (10/24), respectively, with statistical significant difference between the two groups (P<0.05).ConclusionHuayu Kangyou Formula combined with Western medicine can effectively improve the efficacy of Hp-relative peptic ulcer disease, reduce adverse reaction rate and relapse rate.
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BACKGROUND/AIMS: Eradication of Helicobacter pylori is a main treatment of peptic ulcer disease. A triple therapy comprised of a proton pump inhibitor, clarithromycin, and amoxicillin is the most commonly used treatment for H. pylori eradication. The eradication of H. pylori infection requires combination of antibiotics. However, development of antibiotic resistance is a major cause of treatment failure. MATERIALS AND METHODS: This study was to observe H. pyrori eradication rate change for 10 years. From August 2005 to June 2014, a total of 4,891 patients with H. pylori infection were treated with standard H. pylori triple eradication therapy (proton pump inhibitor, amoxicillin, clarithromycin) and were analyzed by urea breath test. RESULTS: The overall rates of eradication with standard triple therapy was 82.8% (4,048/4,891). H. pylori eradication rates decreased from 92.2% in 2005 to 80.2% in 2014 (P=0.037). CONCLUSIONS: This study shows that the overall rate of H. pylori eradication with standard triple therapy decreased meaningfully for 10 years.