Standard First-line Triple Therapy for Helicobacter pylori Infection: A Comparison of Eradication Rates Based on Timing of Administration of Proton Pump Inhibitors

BACKGROUND/AIMS: Recent Korean studies performed over the past few decades have shown diminishing efficacy and unacceptability of clarithromycin-based triple therapy as first-line eradication therapy for Helicobacter pylori infection, based on evidence of a declining eradication rate. Triple therapy continues to be used as first-line eradication therapy despite concerns regarding high clarithromycin resistance among Koreans. Patient compliance and acid suppression are important factors associated with the H. pylori eradication rate. We investigated whether regular administration of a proton pump inhibitor (PPI) 30 minutes before a meal can improve the eradication rate. MATERIALS AND METHODS: We retrospectively analyzed the data of 316 patients who were treated with first-line triple therapy (PPI, amoxicillin, and clarithromycin) for H. pylori infection between January 2012 and September 2017. Patients were divided into 2 groups based on the time of administration of the PPI (group A: before a meal, group B: after a meal). The urea breath test was performed 4~6 weeks after eradication of infection. RESULTS: Notably, 249 patients (78.8%, 249/316) showed successful eradication. The eradication rates in groups A and B were 87.5% (49/56 patients) and 76.9% (200/260 patients), respectively. We observed that regular administration of PPI before meals improved the eradication rate (P=0.079). CONCLUSIONS: We observed that although clarithromycin-based triple therapy was associated with an overall eradication rate <80%, regular PPI administration before meals improved the eradication rate. Regular PPI administration before meals and effective education to improve patient compliance could improve the eradication rate through maximal acid suppression.

Recent First Line Eradication Rate of Helicobacter pylori Infection: Single Center Experience

BACKGROUND/AIMS: For more than a decade, triple therapy (proton pump inhibitor, amoxicillin, clarithromycin) has been the first line eradication regimen for Helicobacter pylori infection in Korea. However, recent studies have proven that its' efficacy is no longer tolerable due to increased resistance of antibiotics. This study is aimed to investigate the current status of triple therapy, quadruple therapy and dual therapy as first line regimen for H. pylori infection in single medical center. MATERIALS AND METHODS: Medical records of patients who received urea breath test after first line eradication therapy from August 2011 to November 2014 were retrospectively analyzed. Patients were divided into three groups according to the first line treatment regimen; triple therapy (proton pump inhibitor (PPI)+clarithromycin+amoxicillin), quadruple therapy (PPI+bismuth+tetracycline+metronidazole), dual therapy (PPI+amoxicillin). RESULTS: A total of 557 patients were reviewed and 429 patients (77.0%) had successful eradication. Among 511 patients who received triple therapy, the eradication rates were 77.1% (394 patients). Eradication rates were 95.2% among quadruple therapy group. Dual therapy group had exceptionally low eradication rates (60.0%). CONCLUSIONS: Even though triple therapy has been recommended as first line regimen in Korea, eradication rates were below 80%. Quadruple therapy as first line regimen showed promising future reaching over 90% eradication rates. However, due to the small number of patients in our study, further studies are necessary to estimate usefulness of quadruple therapy as first line regimen.