Beyond Maastricht IV: are standard empiric triple therapies for Helicobacter pylori still useful in a South-European country?

Detalhes bibliográficos
Autor(a) principal: Almeida, Nuno
Data de Publicação: 2015
Outros Autores: Donato, Maria Manuel, Romãozinho, José Manuel, Luxo, Cristina, Cardoso, Olga, Cipriano, Maria Augusta, Marinho, Carol, Fernandes, Alexandra, Calhau, Carlos, Sofia, Carlos
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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spelling 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
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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)
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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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