High-dose esomeprazole and amoxicillin dual therapy for first-line Helicobacter pylori eradication: a proof of concept study
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Manes, Gianpiero
Alvaro, Domenico
De Francesco, Vincenzo
Ridola, Lorenzo
Bellesia, Annamaria
de Nucci, Germana
Gatta, Luigi
Hassan, Cesare
Zullo, Angelo
Background The prevalence of resistance to clarithromycin and metronidazole has considerably increased, with a corresponding decrease in the eradication rate for Helicobacter pylori (H. pylori) infection. Primary resistance to amoxicillin is extremely low, and esomeprazole was found to exert a noteworthy antimicrobial activity in vitro against H. pylori. A dual therapy with high-dose of esomeprazole coupled with high-dose amoxicillin might be therefore an ideal first-line treatment for H. pylori eradication. We aimed to assess the efficacy of a first-line 10-day, high-dose dual therapy consisting of amoxicillin and esomeprazole to eradicate H. pylori infection.Methods Consecutive naïve H. pylori-infected patients, who underwent an upper endoscopy in 4 Italian hospitals due to dyspeptic symptoms and found to be infected at routine histological assessment, were invited to participate. Patients enrolled received a 10-day, high-dose dual therapy comprising esomeprazole (40 mg t.i.d) and amoxicillin (1 g t.i.d.). At least 4 weeks after the end of the treatment a 13C-urea breath test was performed to evaluate the eradication.Results A total of 56 patients agreed to participate in the study and were all followed-up. The overall eradication was 87.5% (95% CI=78.8•96.2), without a statistically significant difference among centres. Overall, 5 (8.9%; 1.5•16.4%) patients complained of side-effects.Conclusions Th e 10-day, high-dose dual therapy with esomeprazole and amoxicillin might be an effective and safe fi rst-line regimen. Th e effi cacy of a longer 14-day regimen should be tested.Keywords Helicobacter pylori infection, dual therapy, esomeprazole, amoxicillinAnn Gastroenterol 2015; 28 (4): 448-451
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