Eradication Rates for Esomeprazole and Lansoprazole-Based 7-Day Non-Bismuth Concomitant Quadruple Therapy for First-Line Anti- Helicobacter pylori Treatment in Real World Clinical Practice

• Published in: Infection and drug resistance 2021-01, Vol.14, p.1239-1246
• Main Authors: Hung, Kuo-Tung, Yang, Shih-Cheng, Wu, Cheng-Kun, Wang, Hsing-Ming, Yao, Chih-Chien, Liang, Chih-Ming, Tai, Wei-Chen, Wu, Keng-Liang, Kuo, Yuan-Hung, Lee, Chen-Hsiang, Chuah, Seng-Kee
• Format: Article
• Language: English
• Subjects: Amoxicillin; antibiotic resistance; Antibiotics; Bismuth; Care and treatment; Clarithromycin; Comparative analysis; Compliance; concomitant therapy; Diarrhea; Drug resistance in microorganisms; Endoscopy; Eradication; esomeprazole; Gastric cancer; Helicobacter infections; Helicobacter pylori; Infections; Lansoprazole; Metronidazole; Omeprazole; Original Research; Pantoprazole; Patients; Statistical analysis; Tetracycline; Tetracyclines; Ulcers; Urea
• ISSN: 1178-6973; 1178-6973
• DOI: 10.2147/IDR.S304711

Non-bismuth concomitant quadruple therapy is commonly administered in Taiwan, achieving an acceptable efficacy as a first-line anti treatment. This study compared the eradication rates between esomeprazole- and lansoprazole-based non-bismuth concomitant quadruple therapy for first-line anti- treatment. This study included 206 -infected naïve patients between July 2016 and February 2019. The patients were prescribed with either a 7-day non-bismuth containing quadruple therapy (esomeprazole, 40 mg twice daily; amoxicillin, 1 g twice daily; and metronidazole, 500 mg twice daily; and clarithromycin, 500 mg twice daily for 7 days [EACM group]; lansoprazole, 30 mg twice daily; amoxicillin, 1 g twice daily; metronidazole, 500 mg twice daily; and clarithromycin, 500 mg twice daily [LACM group]). Then, the patients were asked to perform urea breath tests 8 weeks later. The eradication rates in the EACM group were 86.1% (95% confidence interval [CI], 77.8%-92.2%) and 90.6% (95% CI, 82.9%-95.6%) in the intention-to-treat (ITT) and the per-protocol (PP) analyses, respectively. Moreover, the eradication rates in the LACM group were 90.1% (95% CI, 82.6%-95.2%) and 92.6% (95% CI, 85.5%-96.9%) in the ITT and the PP analyses, respectively. Consequently, the LACM group exhibited more diarrhea patients than the EACM group (7.1% versus 1.0%, = 0.029), but all symptoms were mild. Univariate analysis in this study showed that metronidazole-resistant strains were the clinical factor affecting the eradications (95.3% versus 78.9%, = 0.044). Moreover, a trend was observed in dual clarithromycin- and metronidazole-resistant strains (91.5% versus 66.7%, = 0.155). The eradication rates between esomeprazole and lansoprazole-based non-bismuth concomitant quadruple therapy for first-line treatment were similar in this study. Both could achieve a > 90% report card in the PP analysis.