ABSTRACT
BACKGROUND: There is some evidence that prior use of macrolide antibiotics is a useful predictor of the likelihood of standard triple therapy failure in Helicobacter pylori eradication. In this study, we have evaluated whether previous intake of macrolides correlates with failure to eradicate H. pylori using two different first-line clarithromycin-containing regimens. MATERIALS AND METHODS: Retrospective study of 212 patients with H. pylori infection treated with one of two first-line clarithromycin-containing regimens: 108 patients treated with triple therapy for 10 days and 104 patients treated with concomitant therapy for 10 days. The intake of macrolides (clarithromycin, azithromycin, and other macrolides) prior to the eradication therapy was obtained from the electronic medical record, which contains information regarding all the medication prescribed to the patients since the year 2004. RESULTS: One hundred of 212 patients (47.2%) had received at least one treatment with macrolides during the years prior to the eradication therapy. H. pylori eradication rates were significantly lower in patients with previous use compared to patients without previous use of macrolides, both with triple therapy (60.8% vs 92.9%; P < .0001) and with concomitant therapy (85.7% vs 98.2%; P = .024). CONCLUSIONS: Previous use of macrolides correlates with a low H. pylori eradication rate with triple and concomitant clarithromycin-containing regimens. In addition, our study shows that in patients without previous use of macrolides, triple therapy achieves per-protocol eradication rates over 90%.
Subject(s)
Clarithromycin/administration & dosage , Clarithromycin/pharmacology , Helicobacter Infections/drug therapy , Helicobacter Infections/microbiology , Helicobacter pylori/drug effects , Macrolides/administration & dosage , Macrolides/pharmacology , Adolescent , Adult , Aged , Aged, 80 and over , Anti-Bacterial Agents/administration & dosage , Anti-Bacterial Agents/pharmacology , Bismuth/therapeutic use , Drug Resistance, Bacterial , Electronic Health Records , Female , Hospitals/statistics & numerical data , Humans , Male , Middle Aged , Retrospective Studies , Spain , Treatment Failure , Young AdultABSTRACT
Hyperthyroidism is one of the most common endocrinology disorders. Treatment can be either pharmacological, surgical or using radioactive iodine. In Europe methimazole is the antithyroid drug of choice because it can be administered in a single daily dose and has a lower risk of adverse reactions. Around 5% of patients taking thionamides can present any of their side effects, which are usually mild. Liver toxicity due to thionamides is very rare, and severe due to propylthiouracil. We present a clinical case of a cholestatic jaundice and acute toxic hepatitis due to methimazole and a cross-reaction with propylthiouracil. Based on this case a review is presented.
Subject(s)
Antithyroid Agents/adverse effects , Chemical and Drug Induced Liver Injury/etiology , Methimazole/adverse effects , Aged , Antithyroid Agents/therapeutic use , Case Management , Cholestasis, Intrahepatic/chemically induced , Female , Graves Disease/drug therapy , Graves Disease/surgery , Humans , Methimazole/therapeutic use , ThyroidectomyABSTRACT
El hipertiroidismo es uno de los trastornos endocrinológicos más frecuentes. Su tratamiento actual consiste en fármacos, yodo radiactivo y cirugía. El metimazol es el fármaco antitiroideo de elección en Europa, porque puede administrarse en una sola dosis diaria y por su menor riesgo de efectos secundarios. En un 5% de los pacientes pueden aparecer efectos secundarios por los fármacos antitiroideos, que suelen ser menores. La enfermedad hepática asociada con estos fármacos es excepcional, y es más común y grave en el caso del propiltiouracilo. Presentamos el caso clínico de un paciente con hipertiroidismo, que desarrolló una hepatitis aguda tóxica colestásica tras la administración de metimazol y, posteriormente, una reacción cruzada con propiltiouracilo. Debido a la rareza del caso, nos parece interesante su presentación.
Hyperthyroidism is one of the most common endocrinology disorders. Treatment can be either pharmacological, surgical or using radioctive iodine. In Europe methimazole is the antithyroid drug of choice because it can be administered in a single daily dose and has a lower risk of adverse reactions. Around 5% of patients taking thionamides can present any of their side effects, which are usually mild. Liver toxicity due to thionamides is very rare, and severe due to propylthiouracil. We present a clinical case of a cholestatic jaundice and acute toxic hepatitis due to methimazole and a cross-reaction with propylthiouracil. Based on this case a review is presented
