Predictors of failure of Helicobacter pylori eradication with the standard 'Maastricht triple therapy'

Aliment Pharmacol Ther. 2001 Jul;15(7):1023-9. doi: 10.1046/j.1365-2036.2001.01006.x.

Abstract

Background: Triple therapy with proton pump inhibitor, clarithromycin and amoxicillin has recently been proposed in Maastricht as first-line treatment for H. pylori infection.

Aim: To determine predictors of unsuccessful eradication.

Methods: Two hundred and forty-eight patients underwent endoscopy with biopsies for rapid urease test, histology and culture with antibiotic susceptibility tests, and 13C-UBT. All infected patients were given pantoprazole (40 mg b.d.), clarithromycin (500 mg b.d.) and amoxicillin (1 g b.d.) for 1 week. Eradication was assessed by UBT at 4-6 weeks after therapy.

Results: One hundred and sixty-two of 248 patients (65%) were infected. Culture was positive in 144 (89%). Prevalence rates of metronidazole, clarithromycin and amoxicillin resistance were 14, 8 and 3%, respectively. Eradication rates (95% CI) were 63% (54.7-70.6) by intention-to-treat analysis and 67% (59.4-75.4) by per protocol analysis. Drug compliance was excellent and side-effects were mild. Age > or = 45 years (OR: 2.35, CI: 1.30-4.25), smoking (OR: 1.37, CI 1.01-1.87) and high pre-treatment UBT results (OR: 1.36, CI: 1.08-1.72) were independent predictors of eradication failure. Gender, endoscopic findings, alcohol intake, and clarithromycin and amoxicillin resistance did not predict treatment failure.

Conclusion: Despite the low prevalence of primary antibiotic resistance in our geographical area, triple therapy with pantoprazole, amoxicillin and clarithromycin achieves low eradication rates. Smoking, age and pre-treatment UBT results are predictors of potential eradication failure.

Publication types

  • Clinical Trial

MeSH terms

  • 2-Pyridinylmethylsulfinylbenzimidazoles
  • Age Factors
  • Amoxicillin / pharmacology*
  • Anti-Bacterial Agents / pharmacology*
  • Anti-Ulcer Agents / pharmacology*
  • Benzimidazoles / pharmacology*
  • Biopsy
  • Breath Tests
  • Clarithromycin / pharmacology*
  • Drug Resistance, Microbial
  • Drug Therapy, Combination
  • Endoscopy
  • Helicobacter Infections / drug therapy*
  • Helicobacter Infections / pathology
  • Humans
  • Omeprazole / analogs & derivatives
  • Pantoprazole
  • Penicillins / pharmacology*
  • Prospective Studies
  • Proton Pump Inhibitors*
  • Risk Factors
  • Smoking / adverse effects*
  • Sulfoxides / pharmacology*
  • Urea / analysis

Substances

  • 2-Pyridinylmethylsulfinylbenzimidazoles
  • Anti-Bacterial Agents
  • Anti-Ulcer Agents
  • Benzimidazoles
  • Penicillins
  • Proton Pump Inhibitors
  • Sulfoxides
  • Amoxicillin
  • Urea
  • Pantoprazole
  • Clarithromycin
  • Omeprazole