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Title: Quinolone-Based Triple Therapy May Be Superior to Conventional Treatment for H. Pylori Eradication: Presented at ACG

"Quinolone-Based Triple Therapy May Be Superior to Conventional Treatment for H. Pylori Eradication: Presented at ACG"

By Charlene Laino BALTIMORE, MD -- October 15, 2003 -- A 7-day regimen incorporating a quinolone antibiotic is an effective eradication therapy for Helicobacter pylori and may lead to better compliance, lower costs and fewer side effects than conventional triple therapy, an open-label study suggests. Ala Sharara MD, associate professor of medicine, American University of Beirut Medical Center, Lebanon, Beirut, presented the findings here on October 12th at the 68th Annual Scientific Meeting of the American College of Gastroenterology (ACG). While adequate therapeutic regimens for the eradication of H. pylori are available, the large number of pills needed and associated adverse events can lead to poor compliance in some patients, said Dr. Sharara, whose presentation was a recipient of the 2003 ACG Presidential Poster Award. More importantly, resistance to clarithromycin -- a cornerstone of standard triple therapy -- is increasing, with rates reaching 16% in some regions of the United States and 26% in parts of Israel and Spain, he said. The new study was performed to test the hypothesis that a fluoroquinolone-based regimen would circumvent this problem of resistance as well as lead to fewer adverse effects and better compliance, Dr. Sharara said. From January to December 2002, 113 patients with a positive rapid urease assay who were undergoing endoscopy were enrolled in the trial. Gastric biopsies from a random cohort of patients showed that the bacteria were "exquisitely sensitive to [the fluoroquinolone] gatifloxacin," said Dr. Sharara, leading his team to conclude that a 1-week regimen would be adequate for eradicating the infection. In contrast, conventional treatment, consisting of a proton pump inhibitor, clarithromycin and either amoxicillin or metronidazole, are all typically given for 10 days to 14 days, he said. The patients were assigned to receive one of two 7-day treatment regimens: 400 mg of gatifloxacin once a day, 1 g of amoxicillin twice a day and 20 mg of rabeprazole, either once or twice a day. Sixteen patients in the group that received 40 mg of rabeprazole daily had failed one or more regimens for H. pylori eradication prior to the trial, Dr. Sharara said. As determined by C-urea breath tests that were done 6 weeks or more after the end of therapy, H. pylori was eradicated in 81% of patients in the arm that received once-daily rabeprazole and 92% of those who received twice-daily rabeprazole. Also, 87.5% of 16 patients who had previously failed conventional therapies were cured. No significant adverse effects were reported. All 50 H. pylori strains recovered were susceptible in vitro to amoxicillin and gatifloxacin, Dr. Sharara said. Noting that conventional triple therapy is associated with eradication rates of 80% to 85% on intent-to-treat analyses, Dr. Sharara concluded that a 7-day regimen of gatifloxacin, amoxicillin and 40 mg of rabeprazole results in superior eradication rates, including in cases of failed primary therapy. "The patient only needs to take five pills a day for 7 days," he added, "which should improve compliance and costs." [Study title: Efficacy Of Two Gatifloxacin-Based Triple Therapies For Helicobacter Pylori Infection. Abstract 12]

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