Abstract
Studies of effects of IL-1 polymorphisms, CYP2C19 genotype together with antibiotic resistance for H. pylori eradication are rare worldwide. The present study was designed to evaluate efficacy of 10-day sequential therapy (SQT) and 14-day standard triple therapy (STT) with four- times-daily dosing of amoxicillin for H. pylori eradication related to these important host and bacterial factors in Thailand. This prospective randomized study was performed during March 2015 to January 2016. H. pylori infected gastritis patients were randomized to receive 10-day sequential therapy and 14-day standard triple therapy. CYP2C19 genotyping, IL1 polymorphism (IL-1B and IL-1RN genotypes) and antibiotic susceptibility tests were performed in all patients. 13C-UBT was conducted to confirm H. pylori eradication at least 4 weeks after treatment. A total of 100 patients (33 males and 67 females, mean age=51.1 years) were enrolled. Eradication rate by PP analysis was 97.9% (47/48) with the 10-day SQT regimen and 87.8% (43/49) with 14-day STT regimen (97.9% vs 87.8%; p-value=0.053). Antibiotic susceptibility testing demonstrated 45% resistance to metronidazole, 14.8% to clarithromycin, and 24.1% to levofloxacin. CYP2C19 genotyping revealed 44.9% RM, 49% IM and 6.1% PM. IL-1B and IL-1RN genotypes were demonstrated as 21.4% for CC, 48.1% for TC, 36.8% for TT, 72.7% for 1/1, and 21.2% for 1/2 genotypes, respectively. The 10-day SQT regimen provided 100% eradication in patients with clarithromycin or dual clarithromycin and levofloxacin H. pylori resistant strains. Moreover, the 10-day SQT regimen resulted in a 100% eradication rate in all patients with CYP2C19 genotype RM and almost type of IL-1B (TC and TT) and IL1-RN genotypes ( 1/2 and other). Treatment with 10-day sequential therapy is highly effective for H. pylori eradication regardless of the effects of clarithromycin resistance, dual clarithromycin and levofloxacin resistance, CYP2C19 genotype, IL-1B and IL1-RN genetic polymorphisms and can be used as effective first line therapy in Thailand.
Highlights
Helicobacter pylori (H. pylori) infection is the main cause of peptic ulcer disease (PUD), mucosa associated lymphoid tissue lymphoma, and gastric cancer (Vilaichone and Mahachai, 2001; Vilaichone et al, 2006)
The present study was designed to evaluate efficacy of 10-day sequential therapy (SQT) and 14-day standard triple therapy (STT) with four- times-daily dosing of amoxicillin for H. pylori eradication related to these important host and bacterial factors in Thailand
CYP2C19 genotyping, IL1 polymorphism (IL-1B and IL-1RN genotypes) and antibiotic susceptibility tests were performed in all patients. 13C-urea breath test (UBT) was conducted to confirm H. pylori eradication at least 4 weeks after treatment
Summary
Helicobacter pylori (H. pylori) infection is the main cause of peptic ulcer disease (PUD), mucosa associated lymphoid tissue lymphoma, and gastric cancer (Vilaichone and Mahachai, 2001; Vilaichone et al, 2006). The global eradication rate of standard triple regimen for H. pylori infection has declined in recent years and no longer recommended as an empiric choice in most countries (Chey and Wong, 2007; Mahachai et al, 2011). Recent study has demonstrated the positive effect of the dosing scheme of amoxicillin significantly influenced eradication rates of triple therapies. One of the popular present first-line treatment options is sequential regimen, which has shown higher eradication rates than conventional triple therapy in several recent meta-analyses (Zullo et al, 2007; Jafri et al, 2008; Gatta et al, 2009). We conduct this study for evaluated efficacy of 10day sequential therapy (SQT) and 14-day standard triple therapy (STT) with four times-daily dosing of amoxicillin for H. pylori eradication in Thai patients with functional dyspepsia as a first line H. pylori eradication in Thailand. Serious adverse reactions were defined as symptoms that disturbed on patients’ daily life
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