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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

Authors Hung KT, Yang SC, Wu CK, Wang HM, Yao CC, Liang CM, Tai WC, Wu KL, Kuo YH, Lee CH, Chuah SK

Received 31 January 2021

Accepted for publication 6 March 2021

Published 25 March 2021 Volume 2021:14 Pages 1239—1246

DOI https://doi.org/10.2147/IDR.S304711

Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Héctor M. Mora-Montes


Kuo-Tung Hung,1 Shih-Cheng Yang,1 Cheng-Kun Wu,1,2 Hsing-Ming Wang,1 Chih-Chien Yao,1 Chih-Ming Liang,1,2 Wei-Chen Tai,1,2 Keng-Liang Wu,1,2 Yuan-Hung Kuo,1,2 Chen-Hsiang Lee,2,3 Seng-Kee Chuah1,2

1Division of Hepatogastroenterology, Department of Internal Medicine, Chang Gung Memorial Hospital, Kaohsiung, Taiwan; 2Chang Gung University, College of Medicine, Taoyuan, Taiwan; 3Division of Infectious Disease, Department of Internal Medicine, Chang Gung Memorial Hospital, Kaohsiung, Taiwan

Correspondence: Seng-Kee Chuah; Chih-Ming Liang
Division of Hepatogastroenterology, Chang Gung Memorial Hospital, 123, Ta-Pei Road, Niao-Sung Hsiang, Kaohsiung, 833, Taiwan
Tel + 886-7-7317123 ext. 8301
Fax + 886-7-7322402
Email [email protected]; [email protected]

Purpose: Non-bismuth concomitant quadruple therapy is commonly administered in Taiwan, achieving an acceptable efficacy as a first-line anti-Helicobacter pylori treatment. This study compared the eradication rates between esomeprazole- and lansoprazole-based non-bismuth concomitant quadruple therapy for first-line anti-H. pylori treatment.
Patients and Methods: This study included 206 H. pylori-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.
Results: 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%, p = 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%, p = 0.044). Moreover, a trend was observed in dual clarithromycin- and metronidazole-resistant strains (91.5% versus 66.7%, p = 0.155).
Conclusion: The eradication rates between esomeprazole and lansoprazole-based non-bismuth concomitant quadruple therapy for first-line H. pylori treatment were similar in this study. Both could achieve a > 90% report card in the PP analysis.

Keywords: Helicobacter pylori, esomeprazole, lansoprazole, concomitant therapy, antibiotic resistance

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