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. 2010 Jul;47(1):53-8.
doi: 10.3164/jcbn.10-10. Epub 2010 Jun 17.

Changes in 12-Year First-Line Eradication Rate of Helicobacter pylori Based on Triple Therapy with Proton Pump Inhibitor, Amoxicillin and Clarithromycin

Makoto Sasaki  1 , Naotaka Ogasawara, Keiko Utsumi, Naohiko Kawamura, Tskeshi Kamiya, Hiromi Kataoka, Satoshi Tanida, Tsutomu Mizoshita, Kunio Kasugai, Takashi Joh
Affiliations

Changes in 12-Year First-Line Eradication Rate of Helicobacter pylori Based on Triple Therapy with Proton Pump Inhibitor, Amoxicillin and Clarithromycin

Makoto Sasaki et al. J Clin Biochem Nutr. 2010 Jul.

Abstract

A triple therapy based on a proton pump inhibitor (PPI), amoxicillin (AMPC), and clarithromycin (CAM) is recommended as a first-line therapy for Helicobacter pylori (H. pylori) eradication and is widely used in Japan. However, a decline in eradication rate associated with an increase in prevalence of CAM resistance is viewed as a problem. We investigated CAM resistance and eradication rates over time retrospectively in 750 patients who had undergone the triple therapy as first-line eradication therapy at Nagoya City University Hospital from 1995 to 2008, divided into four terms (Term 1: 1997-2000, Term 2: 2001-2003, Term 3: 2004-2006, Term 4: 2007-2008). Primary resistance to CAM rose significantly over time from 8.7% to 23.5%, 26.7% and 34.5% while the eradication rate decreased significantly from 90.6% to 80.2%, 76.0% and 74.8%. Based on the PPI type, significant declines in eradication rates were observed with omeprazole or lansoprazole, but not with rabeprazole. A decrease in the H. pylori eradication rate after triple therapy using a PPI + AMPC + CAM has been acknowledged, and an increase in CAM resistance is considered to be a factor. From now on, a first-line eradication regimen that results in a higher eradication rate ought to be investigated.

Keywords: Helicobacter pylori; amoxicillin; clarithromycin resistance; proton pump inhibitor; triple therapy.

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Figures

Fig. 1
Fig. 1
Eradication rates significantly declined from 90.6% (1997–2000) to 80.2% (2001–2003), 76.0% (2004–2006) and 74.8% (2007–2008). The eradication rate of CAM-resistant bacteria (25.0%) was significant lower than that of CAM susceptibility (86.7%). CAM-S, clarithromycin susceptibility; CAM-R, clarithromycin resistance.
Fig. 2
Fig. 2
Primary CAM resistance rose significantly from 8.7% (1997–2000) to 23.5% (2001–2003), 26.7% (2004–2006), and 34.4% (2007–2008).
Fig. 3
Fig. 3
Eradication rates by OPZ/LPZ significantly decline from 91.2% (1995–2000) to 80.2% (2001–2003), 76.0% (2004–2006) and 69.0% (2007–2008). On the other hand, no significant difference was found in the RPZ eradication rates between the term of before 2000 and after 2007. O/LAC, omeprazole or lansoprazole + amoxicillin + clarithromycin regimen. RAC, rabeprazole + amoxicillin + clarithromycin regimen.
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