Efficacy of a tailored PCR-guided triple therapy in the treatment of Helicobacter pylori infection - Archive ouverte HAL Accéder directement au contenu
Article Dans Une Revue Médecine et Maladies Infectieuses Année : 2020

Efficacy of a tailored PCR-guided triple therapy in the treatment of Helicobacter pylori infection

Résumé

Introduction: Resistance to clarithromycin and fluoroquinolones is increasing in many countries. We aimed to assess the efficacy of a tailored PCR-guided triple therapy versus an empirical triple therapy in the treatment of H. pylori infection.Patients and methods: French multicenter prospective open-label randomized study to assess H. pylori and resistance to clarithromycin and levofloxacin with GenoType HelicoDR® test. Patients of the control group were treated with empirical therapy of proton pump inhibitor (PPI), amoxicillin, and clarithromycin for 7 days. Patients of the experimental group with clarithromycin-susceptible strains, clarithromycin-resistant/levofloxacin-susceptible strains, and with clarithromycin-resistant/levofloxacin-resistant strains received tailored therapy of PPI, amoxicillin, and clarithromycin for 7 days, PPI, amoxicillin, and levofloxacin for 10 days, and PPI, amoxicillin, and metronidazole for 14 days, respectively. H. pylori eradication was assessed by 13C urea breath test at least 28 days after the end of treatment.Results: We included 526 patients: 260 (49.4%) were randomly assigned to empirical triple therapy and 266 (50.6%) to tailored therapy. Clarithromycin and levofloxacin resistances were 23.3% and 12.8%, respectively. Follow-up urea breath test was available for 415 (78.9%) patients. Tailored therapy was superior to empirical therapy in terms of eradication (85.5% vs. 73.1%, RR=1.85, 95%CI [1.25-2.78], p=0.003). Findings were consistent in the susceptibility analysis using multiple imputation (RR=1.61, 95%CI [1.14-2.27], P=0.003) and per-protocol analysis (RR=1.89, 95%CI [0.25-2.78], p=0.003).Conclusion: In a country with a high level of clarithromycin resistance, tailored PCR-guided therapy was superior to empirical triple therapy for H. pylori eradication (https://www.ClinicalTrials.gov: NCT01168063).
Fichier principal
Vignette du fichier
S0399077X18301859.pdf (370.36 Ko) Télécharger le fichier
Origine : Fichiers produits par l'(les) auteur(s)

Dates et versions

hal-03477218 , version 1 (22-08-2022)

Licence

Paternité - Pas d'utilisation commerciale

Identifiants

Citer

J.-C. Delchier, S. Bastuji-Garin, J. Raymond, F. Megraud, A. Amiot, et al.. Efficacy of a tailored PCR-guided triple therapy in the treatment of Helicobacter pylori infection. Médecine et Maladies Infectieuses, 2020, 50, pp.492 - 499. ⟨10.1016/j.medmal.2019.06.001⟩. ⟨hal-03477218⟩
48 Consultations
84 Téléchargements

Altmetric

Partager

Gmail Facebook X LinkedIn More