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Susceptibility-guided and empiric therapy equally effective in H. pylori infection

22 May 2019

Susceptibility‐guided therapy is as effective as empiric modified bismuth quadruple therapy for the first-line treatment of Helicobacter pylori infection, with both yielding excellent eradication rates, as shown in a recent trial.

Researchers conducted a multicentre superiority‐design trial, which randomly assigned 382 patients with H. pylori infection to (a) susceptibility‐guided therapies containing esomeprazole 20 mg and amoxicillin 1 g twice daily plus clarithromycin 500 mg, metronidazole 400 mg twice daily, or levofloxacin 500 mg daily for susceptible infections or bismuth 220 mg twice daily and metronidazole 400 mg four times daily for triple‐resistant infections; or to (b) empiric therapy containing esomeprazole 20 mg, bismuth 220 mg twice daily, amoxicillin 1 g and metronidazole 400 mg thrice daily.

Rates of H. pylori eradication were high and similar in the susceptibility‐guided and the empiric regimens (per-protocol rates: 97.7 percent vs 97.6 percent; p=1.00; intent‐to‐treat rates: 91.6 percent vs 85.4 percent; p=0.12).

Overall, susceptibility‐guided therapy was not superior to empiric therapy, with a difference of 0.1 percent in per‐protocol rate and 6.2 percent in intent‐to‐treat rate. Furthermore, both treatment approaches had high adherence and were associated with low adverse event rates.

In light of the findings, researchers pointed out that choosing between the two approaches would depend on availability of susceptibility testing and/or a locally highly effective empiric therapy.

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Most Read Articles
21 Jun 2016
Sofosbuvir-based regimens showed good cost-effectiveness in a majority of patients suffering from chronic hepatitis C, as observed in a systematic review of fourteen studies conducted in seven different countries.
14 May 2019
At the recent GLYCEMIC GUARDIANS™ dinner symposium, three eminent speakers spoke on theindispensable role of medical nutrition therapy (MNT) in improving outcomes for patients with type2 diabetes (T2D).
Yesterday
Treatment with water-free cyclosporine formulation at either 0.1% or 0.05% concentration is tolerable and provides effective relief of the signs of dry eye disease, according to data from a phase II study.
4 days ago
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