AI Summary & Key Takeaways
AI InsightConclusion: The results of this study suggest that azithromycin, amoxicillin, and omeprazole at best is as effective as clarithromycin, amoxicillin, and omeprazole; and this new therapy could be considered as an alternative choice for Helicobacter pylori eradication, especially in geographic areas with lower economic status.
📌 3 Key Takeaways
Abstract
Background/aims: In regarding to azithromycin’s high tissue concentration, long biologic half life, low cost, and excellent anti bacterialprofile for Helicobacter pylori in Iran, we sought to compare an azithromycin-based regimen with an already established clarithromycinbased regimen in regards to the eradication of Helicobacter pylori infection. Material and Methods: A prospective, open label, randomizedcontrolled trial was conducted on 165 patients who presented to gastrointestinal clinics of QOM Medical University Clinics, with complaintof dyspepsia. All patients received upper gastrointestinal endoscopy, and underwent rapid urease test to confirm Helicobacter pylori infection. Patients were randomized to a treatment arm, which consisted of, clarithromycin, amoxicillin, and omeprazole, or another treatmentarm consisting of azithromycin, amoxicillin, and omeprazole. Informed consent was obtained from all patients participating in the trial.Urease breath test was performed in patients 6 weeks after end of treatment to assess eradication. All side effects were recorded. Comparisonbetween the two groups was made using a chi-square test. Result: Seventy six and 89 patients received regimen clarithromycin, amoxicillin,and omeprazole and azithromycin, amoxicillin, and omeprazole, respectively, and completed the study course. Per protocol, eradication ratewas 83% with clarithromycin, amoxicillin, and omeprazole and 75% with azithromycin, amoxicillin, and omeprazole (p =0.158). Eradicationrate for a subgroup of patients with peptic ulcer disease in two groups were 83% and 74%, respectively (p=0.134). Only one patient in eachgroup was compelled to stop the treatment due to a severe skin hypersensitivity reaction. Other lesser side effects were comparable within thetwo groups. Conclusion: The results of this study suggest that azithromycin, amoxicillin, and omeprazole at best is as effective as clarithromycin, amoxicillin, and omeprazole; and this new therapy could be considered as an alternative choice for Helicobacter pylori eradication, especially in geographic areas with lower economic status.
Özet
Amaç: Yüksek doku konsantrasyonu, uzun biyolojik yar› ömrü, mükemmel antibakteriyel profili ve ‹ran'daki düflük maliyeti nedeniyle, Helikobakter pilori infeksiyonu eradikasyonunda azitromisin bazl› rejim ile halen kullan›lan klaritromisin bazl› rejimin karfl›laflt›r›lmas›n› amaçlad›k. Gereç ve Yöntem: QOM T›p Fakültesi Gastroenteroloji Klini¤i’ne dispepsi nedeniyle baflvuran 165 hastada prospektif aç›k etiketli randomize kontrollü bir çal›flma yap›ld›. Bütün hastalara üst gastrointestinal sistem endoskopisi ve Helikobakter pilori infeksiyonunun konfirmasyonu için h›zl› üreaz testi yap›ld›. Hastalar klaritromisin, amoksisilin ve omeprazol'den oluflan bir tedavi kolu ve azitromisin, amoksisilin ve omeprazol'den oluflan bir di¤er kola randomize edildi. Çal›flmaya kat›lan bütün hastalardan ayd›nlat›lm›fl onam al›nd›. Hastalara tedaviden 6 hafta sonra eradikasyonu test etmek için üreaz nefes testi yap›ld›. Bütün yan etkiler kaydedildi. ‹ki grup aras›ndaki karfl›laflt›rmalar ki-kare testiyle yap›ld›. Bulgular: Çal›flmay› klaritromisin, amoksisilin ve omeprazol ve azitromisin, amoksisilin ve omeprazol gruplar›nda s›ras›yla 26 ve 89 hasta tamamlad›. Per protokol eradikasyon oran› klaritromisin, amoksisilin ve omeprazol ile %83 ve azitromisin, amoksisilin ve omeprazol ile %75 idi. ‹ki grupta peptik ülseri olan hastalardaki eradikasyon oran› s›ras›yla %83 ve %74 idi (p=0.134). Her iki gruptan birer hastada ciltte ciddi hipersenstivite reaksiyonu nedeniyle ilaç kesilmesi gerekti. ‹ki grupta daha az ciddi yan etkiler aras›nda fark yoktu. Sonuç: Bu çal›flman›n sonuçlar›na göre azitromisin, amoksisilin ve omeprazol, klaritromisin, amoksisilin ve omeprazol kadar etkindir ve özellikle düflük ekonomik düzeyli co¤rafi bölgelerde Helikobakter pilori eradikasyon tedavisi için alternatif bir seçim olarak düflünülmelidir.