Eradication rate and adherence with high‐dose amoxicillin and proton pump inhibitor as first‐line treatment for Helicobacter pylori infection: Experience from University Hospital in Chile

Abstract

AbstractIntroductionIn Chile, more than 70% of adults are infected by Helicobacter pylori. Clarithromycin should not be used in any regimen if there is >15% resistance to this antibiotic, being greater than 26% in our population. In this scenario, the effectiveness of triple therapy (proton pump inhibitor [PPI], clarithromycin, amoxicillin) was only 63.8%.AimTo evaluate the eradication rate and safety of dual therapy (esomeprazole and amoxicillin) in high doses, through a prospective, observational, and descriptive study.MethodsPatients with a positive urease test obtained in an upper digestive endoscopy were included. Any other previous H. pylori eradication regimen were excluded. All patients were treated with esomeprazole 40 mg three times a day and amoxicillin 750 mg four times a day for 14 days. The eradication rate of the dual therapy was evaluated with the H. pylori stool antigen test (the Pylori‐Strip® test used) 6 weeks after completing the eradication treatment and with at least 14 days without PPI, being a negative result, confirmation of the effectiveness of this regimen.ResultsOf 122 patients, 106 had a negative H. pylori antigen in stool; The intention‐to‐treat and per protocol analysis, the eradication rates were 91.8% [95% CI: 87%–97%] and 94% [95% CI: 90%–98%], respectively. Four patients discontinued treatment due to adverse effects. Smoking and adherence to treatment were associated with eradication rate.ConclusionsIn this cohort of patients with H. pylori infection, high‐dose dual therapy has a high eradication rate and good adherence, raising the possibility that it could be used as first‐line therapy in our country. Studies with a larger number of patients should confirm these results.