Variables Influencing Outcome of Helicobacter pylori Eradication Therapy in South China

Abstract

Therapy combining a proton pump inhibitor (PPI), clarithromycin and either amoxicillin or metronidazole is widely recommended for first-line treatment for Helicobacter pylori infection. The purpose of this study was to examine the outcomes of PPI-containing triple therapy and identify factors influencing the cure rate of H. pylori infection in South China. H. pylori positive patients with different occupations from 25 hospitals in five provinces of South China were enrolled. They received a PPI, metronidazole and amoxicillin triple therapy for a week. H. pylori eradication was evaluated by (13)C-urea breath test 4 weeks after therapy. Association between H. pylori eradication with occupation, gender, age, educational level, and protocol compliance was evaluated by Logistic regression. Six hundred and seventy-five were enrolled. The intention-to-treat and per-protocol analyses showed overall cure rates of 60% (95% CI = 56.3-63.7%) and 64.5% (95% CI = 60.7-68.3%), respectively. Multivariate logistic regression showed that occupation, gender and protocol compliance were positively associated with the eradication rate (p < .01). The cure rate for those who took 80% or more of the prescribed drugs was 64.5% (95% CI = 60.7-68.3%) versus 14.6% (95% CI = 6-29%, p < .001) for those who took less. Lower eradication rates were also observed in farmers and women. The eradication rate with a PPI, metronidazole and amoxicillin triple therapy was unacceptably low in South China. These results suggest that studies of the eradication of H. pylori infection in China must take into account antibiotic resistance as well as patient occupation, gender, and protocol compliance. Gastric cancer and peptic ulcer disease are both important in China making methods to effectively and efficiently eradicate H. pylori a priority.