Correlation between creatinine clearance and Helicobacter pylori infection eradication with sequential and triple therapeutic regimens: a randomised clinical trial

ABSTRACT

Uraemic patients show susceptibility to gastrointestinal mucosal lesions and colonisation by Helicobacter pylori [HP]. Antibiotic resistance constitutes a problem in treatment and bismuth preparations are toxic in uraemic patients. This study aimed to assess the correlation between creatinine clearance [CrCl] and eradication of HP infection with new sequential and standard triple therapeutic regimens. A total of 120 HP-positive patients with renal function impairment and 60 control patients with HP infection were enrolled in this study. Patients were divided into four groups on the basis of CrCl and were randomly assigned to one of the two different regimens A 14-day standard triple therapy with 20 mg omeprazole bid, 1000 mg amoxicillin bid and 500 mg clarithromycin bid and a new sequential regimen with 20 mg omeprazole bid and 1000 mg amoxicillin bid both for 14 days, 500 mg ciprofloxacin bid for the first 7 days and 200 mg furazolidone bid for the last 7 days. Doses of amoxicillin, clarithromycin and ciprofloxacin were reduced to 50% in the cases of CrCl <30 mg dl[-1] One hundred and sixty two out of 180 HP-positive patients [54.3% male, 51.6 +/- 12.1 years] completed treatment in the four groups and were studied. According to renal function they were classified into group A [n = 39], haemodialysis [HD] patients; group B [n = 37], CrCl <30 mg dl[-1] without HD; group C [n = 36], CrCl between 30 and 60 mg dl[-1]; and group D [n = 50], control subjects with CrCl >90 mg dl[-1]. HP was successfully eradicated in 77.7% of patients with standard triple therapy and in 81.4% of patients with the sequential therapy. There was no significant difference among the study groups in the rate of HP-infection eradication with both regimens. HP eradication rates did not differ with both sequential and standard therapeutic regimens in uraemic and non-uraemic patients. We, therefore, prefer the standard triple therapy due to its simplicity and reported