Abstract
This was a prospective, randomized, open-label trial. Patients without previous Helicobacter pylori eradication therapy were randomly assigned to either a high-dose dual therapy (HDDT) group or a traditional clarithromycin/amoxicillin triple therapy (CATT) group. In the HDDT group, patients took rabeprazole, 20 mg, four times per day for three days and then dual therapy with rabeprazole, 20 mg, and amoxicillin, 500 mg, four times per day during the patient’s breakfast, lunch, dinner, and bedtime for 14 days. In the CATT group, patients received conventional triple therapy for 14 days (rabeprazole 20 mg, amoxicillin 1 g, and clarithromycin 500 mg twice per day). In the HDDT group, the success rates of H. pylori eradication were 91.7% (95% confidence interval (CI): 0.78–0.97) by intention-to-treat (ITT) and 94.3% (95% CI: 0.79–0.99) by per-protocol (PP) analysis. In the CATT group, the eradication rates were 77.1% (95% CI: 0.61–0.87) by ITT and 84.3% (95% CI: 0.66–0.94) by PP analysis. The study completion rates were 97.2% (35/36) in the HDDT group. Three-day high-dose rabeprazole induction treatment before dual therapy and a schedule of taking the drug at meal and bed times could achieve an acceptable H. pylori eradication rate (>90%) and good drug compliance.
Highlights
The Helicobacter pylori infection is common worldwide and is strongly associated with gastrointestinal diseases, including peptic ulcers, atrophic gastritis, and gastric cancer [1].Clarithromycin-based triple therapy is recommended in many guidelines as the firstline therapy for the treatment of H. pylori infection
This study aimed to evaluate whether high-dose rabeprazole induction treatment before dual eradication therapy and taking 14-day rabeprazole and amoxicillin simultaneously at meal and bed times could achieve an acceptable H. pylori eradication rate and drug compliance
The exclusion criteria were a history of H. pylori eradication therapy, allergy to the study drug, antibiotic treatment within 1 month before entering this study, taking
Summary
Clarithromycin-based triple therapy is recommended in many guidelines as the firstline therapy for the treatment of H. pylori infection. Because of the increasing antibiotic resistance of H. pylori, the eradication rate of clarithromycin-based triple therapy has decreased below 80% [2,3]. Other combinations for eradication therapy, such as sequential therapy, concomitant therapy, bismuth quadruple therapy, and levofloxacin-based triple therapy, have all been recommended as first-line or rescue therapies [2,3]. The eradication rates of these combinations have been reported to be below 90% by intention-to-treat (ITT) analysis [4]. Clarithromycin resistance cannot be overcome by increasing the dose and duration of treatment [3,5]. H. pylori resistance to amoxicillin is rare [6,7]
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