Efficacy and safety of high-dose amoxicillin combined with esomeprazole dual therapy for the treatment of <i>Helicobacter pylori</i> infection_West China Medical Journal

Authors：

ZHENG Xulin ¹ ,  CHEN Yongjun ^1,2 , YU Xinxin ³ , FENG Lei ² , LONG Xiaoqi ¹ , JIANG Biao ²

1. Gastroenterology Endoscopy Center, Suining Central Hospital, Suining, Sichuan 629000, P. R .China;
2. Department of Gastroenterology, Suining Central Hospital, Suining, Sichuan 629000, P. R .China;
3. First Department of Respiratory and Critical Care Medicine, Suining Central Hospital, Suining, Sichuan 629000, P. R .China;

Corresponding author：

CHEN Yongjun, Email: chenyongjun5262022@163.com

Keywords：

Helicobacter pylori; high-dose; dual therapy; amoxicillin; esomeprazole

DOI：

10.7507/1002-0179.202210128

Video：

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Objective To evaluate the efficacy and safety of high-dose dual therapy (HDDT) in the treatment of Helicobacter pylori (HP) infection. Methods The clinical data of patients with HP infection who were treated in Suining Central Hospital between June 2020 and August 2021 were retrospectively collected. They were divided into HDDT group and bismuth-containing quadruple therapy (BQT) group according to the treatment regimen. The efficacy and adverse reactions of the two treatment regimens were observed. Results A total of 520 patients were included. Among them, there were 284 cases in the HDDT group and 236 cases in the BQT group. By propensity score matching, 223 pairs of patients were successfully matched. The eradication rates of HDDT and BQT were 74.4% and 77.1%, respectively (χ²=0.440, P=0.507), and the incidence of adverse reactions were 9.9% and 16.6%, respectively (χ²=4.395, P=0.036). Conclusion The efficacy of HDDT and BQT in the treatment of HP infection is comparable, but the former has fewer adverse reactions.

Citation： ZHENG Xulin, CHEN Yongjun, YU Xinxin, FENG Lei, LONG Xiaoqi, JIANG Biao. Efficacy and safety of high-dose amoxicillin combined with esomeprazole dual therapy for the treatment of Helicobacter pylori infection. West China Medical Journal, 2023, 38(4): 513-517. doi: 10.7507/1002-0179.202210128 Copy

1.	Burucoa C, Axon A. Epidemiology of Helicobacter pylori infection. Helicobacter, 2017, 22(Suppl 1): e12403.
2.	Ding SZ, Du YQ, Lu H, et al. Chinese consensus report on family-based Helicobacter pylori infection control and management (2021 Edition). Gut, 2022, 71(2): 238-253.
3.	Malfertheiner P, Megraud F, O’Morain CA, et al. Management of Helicobacter pylori infection-the Maastricht V/Florence Consensus Report. Gut, 2017, 66(1): 6-30.
4.	国家消化系统疾病临床医学研究中心(上海), 国家消化道早癌防治中心联盟, 中华医学会消化病学分会幽门螺杆菌学组, 等. 中国幽门螺杆菌根除与胃癌防控的专家共识意见(2019 年, 上海). 中华健康管理学杂志, 2019, 13(4): 285-291.
5.	刘文忠, 谢勇, 陆红, 等. 第五次全国幽门螺杆菌感染处理共识报告. 中国实用内科杂志, 2017, 37(6): 509-524.
6.	Zhu YJ, Zhang Y, Wang TY, et al. High dose PPI-amoxicillin dual therapy for the treatment of Helicobacter pylori infection: a systematic review with meta-analysis. Therap Adv Gastroenterol, 2020, 13: 1756284820937115.
7.	Yang X, Wang JX, Han SX, et al. High dose dual therapy versus bismuth quadruple therapy for Helicobacter pylori eradication treatment: a systematic review and meta-analysis. Medicine (Baltimore), 2019, 98(7): e14396.
8.	Yang J, Zhang Y, Fan L, et al. Eradication efficacy of modified dual therapy compared with bismuth-containing quadruple therapy as a first-line treatment of Helicobacter pylori. Am J Gastroenterol, 2019, 114(3): 437-445.
9.	Song Z, Zhou L, Xue Y, et al. A comparative study of 14-day dual therapy (esomeprazole and amoxicillin four times daily) and triple plus bismuth therapy for first-line Helicobacter pylori infection eradication: a randomized trial. Helicobacter, 2020, 25(6): e12762.
10.	Pan KF, Zhang L, Gerhard M, et al. A large randomised controlled intervention trial to prevent gastric cancer by eradication of Helicobacter pylori in Linqu County, China: baseline results and factors affecting the eradication. Gut, 2016, 65(1): 9-18.
11.	Abdullahi M, Annibale B, Capoccia D, et al. The eradication of Helicobacter pylori is affected by body mass index (BMI). Obes Surg, 2008, 18(11): 1450-1454.
12.	Jiang F, Guo CG, Cheung KS, et al. Age of eradication and failure rates of clarithromycin-containing triple therapy for Helicobacter pylori: a 15-year population-based study. Helicobacter, 2022, 27(3): e12893.
13.	Furuta T, Sugimoto M, Yamade M, et al. Effect of dosing schemes of amoxicillin on eradication rates of Helicobacter pylori with amoxicillin-based triple therapy. J Clin Pharmacol, 2014, 54(3): 258-266.
14.	Marcus EA, Inatomi N, Nagami GT, et al. The effects of varying acidity on Helicobacter pylori growth and the bactericidal efficacy of ampicillin. Aliment Pharmacol Ther, 2012, 36(10): 972-979.
15.	Yun J, Wu Z, Qi G, et al. The high-dose amoxicillin-proton pump inhibitor dual therapy in eradication of infection. Expert Rev Gastroenterol Hepatol, 2021, 15(2): 149-157.
16.	Ke H, Li J, Lu B, et al. The appropriate cutoff gastric pH value for Helicobacter pylori eradication with bismuth-based quadruple therapy. Helicobacter, 2021, 26(1): e12768.
17.	Graham DY, Lu H, Dore MP. Relative potency of proton-pump inhibitors, Helicobacter pylori therapy cure rates, and meaning of double-dose PPI. Helicobacter, 2019, 24(1): e12554.
18.	Hu JL, Yang J, Zhou YB, et al. Optimized high-dose amoxicillin-proton-pump inhibitor dual therapies fail to achieve high cure rates in China. Saudi J Gastroenterol, 2017, 23(5): 275-280.
19.	高采平, 肖迅, 刘培曦, 等. 大剂量阿莫西林/埃索美拉唑二联方案根除幽门螺杆菌. 世界华人消化杂志, 2018, 26(6): 353-359.
20.	Öztürk K, Kurt Ö, Çelebi G, et al. High-dose dual therapy is effective as first-line treatment for Helicobacter pylori infection. Turk J Gastroenterol, 2020, 31(3): 234-238.
21.	Hwong-Ruey Leow A, Chang JV, Goh KL. Searching for an optimal therapy for H pylori eradication: high-dose proton-pump inhibitor dual therapy with amoxicillin vs. standard triple therapy for 14 days. Helicobacter, 2020, 25(5): e12723.
22.	Zullo A, Ridola L, Francesco VD, et al. High-dose esomeprazole and amoxicillin dual therapy for first line Helicobacter pylori eradication: a proof of concept study. Ann Gastroenterol, 2015, 28(4): 448-451.
23.	Miehlke S, Kirsch C, Schneider-Brachert W, et al. A prospective, randomized study of quadruple therapy and high-dose dual therapy for treatment of Helicobacter pylori resistant to both metronidazole and clarithromycin. Helicobacter, 2003, 8(4): 310-319.
24.	Shirai N, Sugimoto M, Kodaira C, et al. Dual therapy with high doses of rabeprazole and amoxicillin versus triple therapy with rabeprazole, amoxicillin, and metronidazole as a rescue regimen for Helicobacter pylori infection after the standard triple therapy. Eur J Clin Pharmacol, 2007, 63(8): 743-749.
25.	Sapmaz F, Kalkan IH, Atasoy P, et al. A non-inferiority study: modified dual therapy consisting higher doses of rabeprazole is as successful as standard quadruple therapy in eradication of Helicobacter pylori. Am J Ther, 2017, 24(4): e393-e398.
26.	Kakiuchi T, Matsuo M, Endo H, et al. Gastrointestinal adverse reactions reduce the success rate of Helicobacter pylori eradication therapy: a multicenter prospective cohort study. Helicobacter, 2021, 26(2): e12776.

1. Burucoa C, Axon A. Epidemiology of Helicobacter pylori infection. Helicobacter, 2017, 22(Suppl 1): e12403.
2. Ding SZ, Du YQ, Lu H, et al. Chinese consensus report on family-based Helicobacter pylori infection control and management (2021 Edition). Gut, 2022, 71(2): 238-253.
3. Malfertheiner P, Megraud F, O’Morain CA, et al. Management of Helicobacter pylori infection-the Maastricht V/Florence Consensus Report. Gut, 2017, 66(1): 6-30.
4. 国家消化系统疾病临床医学研究中心(上海), 国家消化道早癌防治中心联盟, 中华医学会消化病学分会幽门螺杆菌学组, 等. 中国幽门螺杆菌根除与胃癌防控的专家共识意见(2019 年, 上海). 中华健康管理学杂志, 2019, 13(4): 285-291.
5. 刘文忠, 谢勇, 陆红, 等. 第五次全国幽门螺杆菌感染处理共识报告. 中国实用内科杂志, 2017, 37(6): 509-524.
6. Zhu YJ, Zhang Y, Wang TY, et al. High dose PPI-amoxicillin dual therapy for the treatment of Helicobacter pylori infection: a systematic review with meta-analysis. Therap Adv Gastroenterol, 2020, 13: 1756284820937115.
7. Yang X, Wang JX, Han SX, et al. High dose dual therapy versus bismuth quadruple therapy for Helicobacter pylori eradication treatment: a systematic review and meta-analysis. Medicine (Baltimore), 2019, 98(7): e14396.
8. Yang J, Zhang Y, Fan L, et al. Eradication efficacy of modified dual therapy compared with bismuth-containing quadruple therapy as a first-line treatment of Helicobacter pylori. Am J Gastroenterol, 2019, 114(3): 437-445.
9. Song Z, Zhou L, Xue Y, et al. A comparative study of 14-day dual therapy (esomeprazole and amoxicillin four times daily) and triple plus bismuth therapy for first-line Helicobacter pylori infection eradication: a randomized trial. Helicobacter, 2020, 25(6): e12762.
10. Pan KF, Zhang L, Gerhard M, et al. A large randomised controlled intervention trial to prevent gastric cancer by eradication of Helicobacter pylori in Linqu County, China: baseline results and factors affecting the eradication. Gut, 2016, 65(1): 9-18.
11. Abdullahi M, Annibale B, Capoccia D, et al. The eradication of Helicobacter pylori is affected by body mass index (BMI). Obes Surg, 2008, 18(11): 1450-1454.
12. Jiang F, Guo CG, Cheung KS, et al. Age of eradication and failure rates of clarithromycin-containing triple therapy for Helicobacter pylori: a 15-year population-based study. Helicobacter, 2022, 27(3): e12893.
13. Furuta T, Sugimoto M, Yamade M, et al. Effect of dosing schemes of amoxicillin on eradication rates of Helicobacter pylori with amoxicillin-based triple therapy. J Clin Pharmacol, 2014, 54(3): 258-266.
14. Marcus EA, Inatomi N, Nagami GT, et al. The effects of varying acidity on Helicobacter pylori growth and the bactericidal efficacy of ampicillin. Aliment Pharmacol Ther, 2012, 36(10): 972-979.
15. Yun J, Wu Z, Qi G, et al. The high-dose amoxicillin-proton pump inhibitor dual therapy in eradication of infection. Expert Rev Gastroenterol Hepatol, 2021, 15(2): 149-157.
16. Ke H, Li J, Lu B, et al. The appropriate cutoff gastric pH value for Helicobacter pylori eradication with bismuth-based quadruple therapy. Helicobacter, 2021, 26(1): e12768.
17. Graham DY, Lu H, Dore MP. Relative potency of proton-pump inhibitors, Helicobacter pylori therapy cure rates, and meaning of double-dose PPI. Helicobacter, 2019, 24(1): e12554.
18. Hu JL, Yang J, Zhou YB, et al. Optimized high-dose amoxicillin-proton-pump inhibitor dual therapies fail to achieve high cure rates in China. Saudi J Gastroenterol, 2017, 23(5): 275-280.
19. 高采平, 肖迅, 刘培曦, 等. 大剂量阿莫西林/埃索美拉唑二联方案根除幽门螺杆菌. 世界华人消化杂志, 2018, 26(6): 353-359.
20. Öztürk K, Kurt Ö, Çelebi G, et al. High-dose dual therapy is effective as first-line treatment for Helicobacter pylori infection. Turk J Gastroenterol, 2020, 31(3): 234-238.
21. Hwong-Ruey Leow A, Chang JV, Goh KL. Searching for an optimal therapy for H pylori eradication: high-dose proton-pump inhibitor dual therapy with amoxicillin vs. standard triple therapy for 14 days. Helicobacter, 2020, 25(5): e12723.
22. Zullo A, Ridola L, Francesco VD, et al. High-dose esomeprazole and amoxicillin dual therapy for first line Helicobacter pylori eradication: a proof of concept study. Ann Gastroenterol, 2015, 28(4): 448-451.
23. Miehlke S, Kirsch C, Schneider-Brachert W, et al. A prospective, randomized study of quadruple therapy and high-dose dual therapy for treatment of Helicobacter pylori resistant to both metronidazole and clarithromycin. Helicobacter, 2003, 8(4): 310-319.
24. Shirai N, Sugimoto M, Kodaira C, et al. Dual therapy with high doses of rabeprazole and amoxicillin versus triple therapy with rabeprazole, amoxicillin, and metronidazole as a rescue regimen for Helicobacter pylori infection after the standard triple therapy. Eur J Clin Pharmacol, 2007, 63(8): 743-749.
25. Sapmaz F, Kalkan IH, Atasoy P, et al. A non-inferiority study: modified dual therapy consisting higher doses of rabeprazole is as successful as standard quadruple therapy in eradication of Helicobacter pylori. Am J Ther, 2017, 24(4): e393-e398.
26. Kakiuchi T, Matsuo M, Endo H, et al. Gastrointestinal adverse reactions reduce the success rate of Helicobacter pylori eradication therapy: a multicenter prospective cohort study. Helicobacter, 2021, 26(2): e12776.

West China Medical Journal

Efficacy and safety of high-dose amoxicillin combined with esomeprazole dual therapy for the treatment of Helicobacter pylori infection

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