Comparison of the Efficacy and Economy of Sequential Therapy and Triple Therapy of Esomeprazole Combined with Clarithromycin and Amoxicillin for Hp Positive Duodenal Ulcer

Abstract

Abstract: objective To analyze and compare the efficacy and economy of sequential therapy and triple therapy of esomeprazole combined with clarithromycin and amoxicillin for Helicobacter pylori (Hp) positive duodenal ulcer, and provide the reference for eradication of Hp. Methods 290 patients with Hp positive duodenal ulcer from January 2015 to June 2016 in our hospital were studied prospectively. All of the patients were divided into three groups according to the visiting sequence, including 97 cases who received the modified sequential therapy as the modified sequential group, 97 cases who received the traditional sequential therapy as the traditional sequential group, and 96 cases who received the standard triple therapy as the standard triple group. Patients in the modified sequential group were provided 20 mg of esomeprazole, 500 mg of clarithromycin twice daily for the first 5 days, followed by 20 mg of esomeprazole, 500 mg of clarithromycin, and 1 000 mg of amoxicillintwice daily for the remaining 5 days. Patients in the traditional sequential group were given 20 mg of esomeprazole, 1 000 mg of amoxicillin twice daily for the first 5 days, followed by 20 mg of esomeprazole, 500 mg of clarithromycin, and 1 000 mg of amoxicillin twice daily for the remaining 5 days. Patients in the standard triple group received 20 mg of esomeprazole, 500 mg of clarithromycin, and 1 000 mg of amoxicillin twice daily for standard 10-day therapy. All of the drugs were administered 2 times a day, the course of treatment was 10 days. The Hp eradication rate and adverse reaction of 3 groups were observed, the efficacy and cost analysis of the 3 groups were evaluated. Results A total of 275 patients were followed-up at the end of study, the Hp eradication rates of the modified sequential group, the traditional sequential group and the standard triple group were 88.66%(ITT) and 92.47%(PP), 84.54%(ITT) and 89.13% (PP), 72.92%(ITT) and 77.78%(PP).The Hp eradication rates of the modified sequential group and traditional sequential group were significantly higher than those of the standard triple group (P < 0.05). 247 cases of Hp were isolated and cultured successfully, resistant rate of clarithromycin was 13.36% (33/247), no amoxicillin resistant strains. The eradication rates of clarithromycin resistant Hp in the modified sequential group, traditional sequential group and standard triple group were 81.82% (9/11), 80.00% (8/10) and 33.33% (4/12) respectively, and the eradication rate in the modified sequential group and traditional sequential group were significantly higher than that in the standard triple group (P < 0.05). The eradication rates of sensitive strains in three groups were 93.90% (77/82), 90.24% (74/82) and 84.62% (66/78) respectively, without significant difference among the three groups (P > 0.05). There was no significant difference in the total effective rate and incidence of adverse reactions among the three groups (P > 0.05). The cost-effectiveness ratio and incremental cost-effectiveness ratio of the modified sequential group and traditional sequential group were slightly better than those of the standard triple group. Conclusion The sequential therapy and triple therapy of esomeprazole combined with clarithromycin and amoxicillin can be effective for Hp positive duodenal ulcer. However, the sequential therapy has higher Hp eradication rate and economic value than the standard triple therapy. The modified improved penetration therapy did not show any advantages in this study and still need to be further explored.

Key words: esomeprazole, clarithromycin, amoxicillin, modified sequential therapy, Helicobacter pylori, standard triple therapy

CLC Number:

R975

WU Jian-ye, ZHOU Ying-qun, GUO Chuan-yong. Comparison of the Efficacy and Economy of Sequential Therapy and Triple Therapy of Esomeprazole Combined with Clarithromycin and Amoxicillin for Hp Positive Duodenal Ulcer[J]. Chinese Journal of Pharmacovigilance, 2016, 13(10): 581-586.

References

[1] 甘远, 黄方华, 王瑞云,等. 幽门螺杆菌感染的治疗现状及进展[J]. 海南医学, 2016, 27(9): 1483-5.
[2] Hunt R H, Xiao S D, Megraud F, et al. World Gastroenterology rganization. World Gastroenterology Organisation Global Guideline: Helicobacter pylori, in Developing Countries[J]. Journal of Gastrointestinal & Liver Diseases Jgld, 2011, 20(3):299-304.
[3] Sezgin O, Barlas I O, Uçbilek E, et al. Modified sequential Helicobacter pylori eradication therapy using high dose omeprazole and amoxicillin in the initial phase in the extensive metaboliser Turkish patients for CYP2C19 polymorphism is ineffective[J]. Acta gastro-enterologicaBelgica,2014, 77(1):3-7.
[4] Zhou Y Q, Xu L, Wang B F, et al. Modified Sequential Therapy Regimen versus Conventional Triple Therapy for Helicobacter Pylori Eradication in Duodenal Ulcer Patients in China: A Multicenter Clinical Comparative Study[J]. Gastroenterology Research & Practice, 2012, 2012(5):129-134.
[5] Chul, Chung, Sung, et al. Dual-priming oligonucleotide-based multiplex PCR using tissue samples in rapid urease test in the detection of Helicobacter pylori infection[J]. World Journal of Gastroenterology, 2014, 20(21):6547-6553.
[6] 储建坤, 崔东升, 朱秀芳,等. HpSA检查与14C尿素呼气试验检测幽门螺杆菌临床对比[J]. 中国老年学杂志, 2015, 35(2):315-316.
[7] Weiss T, Schönfeld N, Otto-Knapp R, et al. Low minimal inhibitory concentrations of linezolid against multidrug-resistant tuberculosis strains[J]. European Respiratory Journal, 2015, 45(1):285-287.
[8] Lin Y F, Chen C Y, Tsai M H, et al. Duodenal ulcer-related antigens from Helicobacter pylori: immunoproteome and protein microarray approaches[J]. Molecular & Cellular Proteomics Mcp, 2007, 6(6): 1018-1026.
[9] 郭庆红, 李强, 路红,等. 不同方案根除幽门螺杆菌的疗效比较[J]. 兰州大学学报(医学版), 2014, 40(1):62-65.
[10] Giorgio F, Principi M, Francesco V D, et al. Primary clarithromycin resistance to Helicobacter pylori : Is this the main reason for triple therapy failure?[J]. World Journal of Gastrointestinal Pathophysiology, 2013, 4(3):43-46.
[11] 付尚勤, 谢步善, 万伦常. 益生菌联合标准三联疗法治疗Hp阳性消化性溃疡的疗效[J]. 实用临床医药杂志, 2014, 18(13):111-112.
[12] De Francesco V, Hassan C, Ridola L, er al. Sequential, concomitant and hybrid first-line therapies for Helicobacter pylori eradication: a prospective randomized study[J]. J Med Microbiol, 2014, 63(5):748-752.
[13] Vaira D, Zullo A, Vakil N, et al. Sequential Therapy versus Triple Therapy for Helicobacter pylori Eradication[J]. Helicobacter, 2007,12(4): 424.
[14] Seddik H, Ahid S, El Adioui T, et al. Sequential therapy versus standard triple-drug therapy for Helicobacter pylori eradication: a prospective randomized study[J]. European Journal of Clinical Pharmacology, 2013, 69(9):1709-1715.
[15] Uygun A, Kadayifci A, Yesilova Z, et al. Comparison of sequential and standard triple-drug regimen for Helicobacter pylori, eradication:A 14-day, open-label, randomized, prospective, parallel-arm study in adult patients with nonulcer dyspepsia[J]. Journal of Clinical Periodontology, 2008, 30(2):154-158.
[16] 张茹, 钱家鸣. 序贯疗法根除幽门螺杆菌[J]. 医学与哲学, 2009,30(18):13-16.
[17] Tsay F W, Wu D C, Kao S S, et al. Reverse Sequential Therapy Achieves a Similar Eradication Rate as Standard Sequential Therapy for Helicobacter pylori, Eradication: A Randomized Controlled Trial[J]. Helicobacter, 2015, 20(1):71-77.
[18] 廖妍, 白岚. H + -K + -ATP酶的分布及其抑制剂PPI的作用[J].广东医学, 2016, 37(9): 1397-1399.
[19] 徐建峰. 埃索美拉唑、克拉霉素、阿莫西林联合治疗幽门螺杆菌阳性胃溃疡患者102例疗效观察[J]. 中国临床医生杂志,2015, 43(5):51-53.