Beyond Maastricht IV: are standard empiric triple therapies for Helicobacter pylori still useful in a South-European country?
Autor(a) principal: | |
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Data de Publicação: | 2015 |
Outros Autores: | , , , , , , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
Texto Completo: | http://hdl.handle.net/10316/109078 https://doi.org/10.1186/s12876-015-0245-y |
Resumo: | Background: Empiric triple treatments for Helicobacter pylori (H. pylori) are increasingly unsuccessful. We evaluated factors associated with failure of these treatments in the central region of Portugal. Methods: This single-center, prospective study included 154 patients with positive 13C-urea breath test (UBT). Patients with no previous H. pylori treatments (Group A, n = 103) received pantoprazole 40 mg 2×/day, amoxicillin 1000 mg 12/12 h and clarithromycin (CLARI) 500 mg 12/12 h, for 14 days. Patients with previous failed treatments (Group B, n = 51) and no history of levofloxacin (LVX) consumption were prescribed pantoprazole 40 mg 2×/day, amoxicillin 1000 mg 12/12 h and LVX 250 mg 12/12 h, for 10 days. H. pylori eradication was assessed by UBT 6–10 weeks after treatment. Compliance and adverse events were assessed by verbal and written questionnaires. Risk factors for eradication failure were determined by multivariate analysis. Results: Intention-to-treat and per-protocol eradication rates were Group A: 68.9% (95% CI: 59.4–77.1%) and 68.8% (95% CI: 58.9–77.2%); Group B: 52.9% (95% CI: 39.5–66%) and 55.1% (95% CI: 41.3–68.2%), with 43.7% of Group A and 31.4% of Group B reporting adverse events. Main risk factors for failure were H. pylori resistance to CLARI and LVX in Groups A and B, respectively. Another independent risk factor in Group A was history of frequent infections (OR = 4.24; 95% CI 1.04–17.24). For patients with no H. pylori resistance to CLARI, a history of frequent infections (OR = 4.76; 95% CI 1.24–18.27) and active tobacco consumption (OR = 5.25; 95% CI 1.22–22.69) were also associated with eradication failure. Conclusions: Empiric first and second-line triple treatments have unacceptable eradication rates in the central region of Portugal and cannot be used, according to Maastricht recommendations. Even for cases with no H. pylori resistance to the used antibiotics, results were unacceptable and, at least for CLARI, are influenced by history of frequent infections and tobacco consumption. |
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Beyond Maastricht IV: are standard empiric triple therapies for Helicobacter pylori still useful in a South-European country?ClarithromycinComplianceHelicobacter pyloriLevofloxacinTreatment failure2-PyridinylmethylsulfinylbenzimidazolesAdultAgedAmoxicillinAnti-Bacterial AgentsBreath TestsClarithromycinDrug Resistance, BacterialDrug Therapy, CombinationFemaleHelicobacter InfectionsHumansLevofloxacinMaleMedication AdherenceMiddle AgedNitroimidazolesPantoprazolePortugalProspective StudiesProton Pump InhibitorsTreatment FailureYoung AdultHelicobacter pyloriBackground: Empiric triple treatments for Helicobacter pylori (H. pylori) are increasingly unsuccessful. We evaluated factors associated with failure of these treatments in the central region of Portugal. Methods: This single-center, prospective study included 154 patients with positive 13C-urea breath test (UBT). Patients with no previous H. pylori treatments (Group A, n = 103) received pantoprazole 40 mg 2×/day, amoxicillin 1000 mg 12/12 h and clarithromycin (CLARI) 500 mg 12/12 h, for 14 days. Patients with previous failed treatments (Group B, n = 51) and no history of levofloxacin (LVX) consumption were prescribed pantoprazole 40 mg 2×/day, amoxicillin 1000 mg 12/12 h and LVX 250 mg 12/12 h, for 10 days. H. pylori eradication was assessed by UBT 6–10 weeks after treatment. Compliance and adverse events were assessed by verbal and written questionnaires. Risk factors for eradication failure were determined by multivariate analysis. Results: Intention-to-treat and per-protocol eradication rates were Group A: 68.9% (95% CI: 59.4–77.1%) and 68.8% (95% CI: 58.9–77.2%); Group B: 52.9% (95% CI: 39.5–66%) and 55.1% (95% CI: 41.3–68.2%), with 43.7% of Group A and 31.4% of Group B reporting adverse events. Main risk factors for failure were H. pylori resistance to CLARI and LVX in Groups A and B, respectively. Another independent risk factor in Group A was history of frequent infections (OR = 4.24; 95% CI 1.04–17.24). For patients with no H. pylori resistance to CLARI, a history of frequent infections (OR = 4.76; 95% CI 1.24–18.27) and active tobacco consumption (OR = 5.25; 95% CI 1.22–22.69) were also associated with eradication failure. Conclusions: Empiric first and second-line triple treatments have unacceptable eradication rates in the central region of Portugal and cannot be used, according to Maastricht recommendations. Even for cases with no H. pylori resistance to the used antibiotics, results were unacceptable and, at least for CLARI, are influenced by history of frequent infections and tobacco consumption.Springer Nature2015-02-15info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articlehttp://hdl.handle.net/10316/109078http://hdl.handle.net/10316/109078https://doi.org/10.1186/s12876-015-0245-yeng1471-230XAlmeida, NunoDonato, Maria ManuelRomãozinho, José ManuelLuxo, CristinaCardoso, OlgaCipriano, Maria AugustaMarinho, CarolFernandes, AlexandraCalhau, CarlosSofia, Carlosinfo:eu-repo/semantics/openAccessreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAP2023-09-27T07:56:27Zoai:estudogeral.uc.pt:10316/109078Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-19T21:25:17.335451Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse |
dc.title.none.fl_str_mv |
Beyond Maastricht IV: are standard empiric triple therapies for Helicobacter pylori still useful in a South-European country? |
title |
Beyond Maastricht IV: are standard empiric triple therapies for Helicobacter pylori still useful in a South-European country? |
spellingShingle |
Beyond Maastricht IV: are standard empiric triple therapies for Helicobacter pylori still useful in a South-European country? Almeida, Nuno Clarithromycin Compliance Helicobacter pylori Levofloxacin Treatment failure 2-Pyridinylmethylsulfinylbenzimidazoles Adult Aged Amoxicillin Anti-Bacterial Agents Breath Tests Clarithromycin Drug Resistance, Bacterial Drug Therapy, Combination Female Helicobacter Infections Humans Levofloxacin Male Medication Adherence Middle Aged Nitroimidazoles Pantoprazole Portugal Prospective Studies Proton Pump Inhibitors Treatment Failure Young Adult Helicobacter pylori |
title_short |
Beyond Maastricht IV: are standard empiric triple therapies for Helicobacter pylori still useful in a South-European country? |
title_full |
Beyond Maastricht IV: are standard empiric triple therapies for Helicobacter pylori still useful in a South-European country? |
title_fullStr |
Beyond Maastricht IV: are standard empiric triple therapies for Helicobacter pylori still useful in a South-European country? |
title_full_unstemmed |
Beyond Maastricht IV: are standard empiric triple therapies for Helicobacter pylori still useful in a South-European country? |
title_sort |
Beyond Maastricht IV: are standard empiric triple therapies for Helicobacter pylori still useful in a South-European country? |
author |
Almeida, Nuno |
author_facet |
Almeida, Nuno Donato, Maria Manuel Romãozinho, José Manuel Luxo, Cristina Cardoso, Olga Cipriano, Maria Augusta Marinho, Carol Fernandes, Alexandra Calhau, Carlos Sofia, Carlos |
author_role |
author |
author2 |
Donato, Maria Manuel Romãozinho, José Manuel Luxo, Cristina Cardoso, Olga Cipriano, Maria Augusta Marinho, Carol Fernandes, Alexandra Calhau, Carlos Sofia, Carlos |
author2_role |
author author author author author author author author author |
dc.contributor.author.fl_str_mv |
Almeida, Nuno Donato, Maria Manuel Romãozinho, José Manuel Luxo, Cristina Cardoso, Olga Cipriano, Maria Augusta Marinho, Carol Fernandes, Alexandra Calhau, Carlos Sofia, Carlos |
dc.subject.por.fl_str_mv |
Clarithromycin Compliance Helicobacter pylori Levofloxacin Treatment failure 2-Pyridinylmethylsulfinylbenzimidazoles Adult Aged Amoxicillin Anti-Bacterial Agents Breath Tests Clarithromycin Drug Resistance, Bacterial Drug Therapy, Combination Female Helicobacter Infections Humans Levofloxacin Male Medication Adherence Middle Aged Nitroimidazoles Pantoprazole Portugal Prospective Studies Proton Pump Inhibitors Treatment Failure Young Adult Helicobacter pylori |
topic |
Clarithromycin Compliance Helicobacter pylori Levofloxacin Treatment failure 2-Pyridinylmethylsulfinylbenzimidazoles Adult Aged Amoxicillin Anti-Bacterial Agents Breath Tests Clarithromycin Drug Resistance, Bacterial Drug Therapy, Combination Female Helicobacter Infections Humans Levofloxacin Male Medication Adherence Middle Aged Nitroimidazoles Pantoprazole Portugal Prospective Studies Proton Pump Inhibitors Treatment Failure Young Adult Helicobacter pylori |
description |
Background: Empiric triple treatments for Helicobacter pylori (H. pylori) are increasingly unsuccessful. We evaluated factors associated with failure of these treatments in the central region of Portugal. Methods: This single-center, prospective study included 154 patients with positive 13C-urea breath test (UBT). Patients with no previous H. pylori treatments (Group A, n = 103) received pantoprazole 40 mg 2×/day, amoxicillin 1000 mg 12/12 h and clarithromycin (CLARI) 500 mg 12/12 h, for 14 days. Patients with previous failed treatments (Group B, n = 51) and no history of levofloxacin (LVX) consumption were prescribed pantoprazole 40 mg 2×/day, amoxicillin 1000 mg 12/12 h and LVX 250 mg 12/12 h, for 10 days. H. pylori eradication was assessed by UBT 6–10 weeks after treatment. Compliance and adverse events were assessed by verbal and written questionnaires. Risk factors for eradication failure were determined by multivariate analysis. Results: Intention-to-treat and per-protocol eradication rates were Group A: 68.9% (95% CI: 59.4–77.1%) and 68.8% (95% CI: 58.9–77.2%); Group B: 52.9% (95% CI: 39.5–66%) and 55.1% (95% CI: 41.3–68.2%), with 43.7% of Group A and 31.4% of Group B reporting adverse events. Main risk factors for failure were H. pylori resistance to CLARI and LVX in Groups A and B, respectively. Another independent risk factor in Group A was history of frequent infections (OR = 4.24; 95% CI 1.04–17.24). For patients with no H. pylori resistance to CLARI, a history of frequent infections (OR = 4.76; 95% CI 1.24–18.27) and active tobacco consumption (OR = 5.25; 95% CI 1.22–22.69) were also associated with eradication failure. Conclusions: Empiric first and second-line triple treatments have unacceptable eradication rates in the central region of Portugal and cannot be used, according to Maastricht recommendations. Even for cases with no H. pylori resistance to the used antibiotics, results were unacceptable and, at least for CLARI, are influenced by history of frequent infections and tobacco consumption. |
publishDate |
2015 |
dc.date.none.fl_str_mv |
2015-02-15 |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://hdl.handle.net/10316/109078 http://hdl.handle.net/10316/109078 https://doi.org/10.1186/s12876-015-0245-y |
url |
http://hdl.handle.net/10316/109078 https://doi.org/10.1186/s12876-015-0245-y |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
1471-230X |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.publisher.none.fl_str_mv |
Springer Nature |
publisher.none.fl_str_mv |
Springer Nature |
dc.source.none.fl_str_mv |
reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação instacron:RCAAP |
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Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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RCAAP |
institution |
RCAAP |
reponame_str |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
collection |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
repository.name.fl_str_mv |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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1799134135757832192 |