NEW YORK (Reuters Health) Nov 15 - A novel regimen using 3 antibiotics and a proton pump inhibitor (PPI) is highly active against Helicobacter pylori in treatment-naive patients, researchers report in a paper online October 11 in the American Journal of Gastroenterology.
This quadruple drug regimen comprised levofloxacin, omeprazole, nitazoxanide, and doxycycline (LOAD). This regimen has a "very high eradication rate" and "virtually negligible" side effects, lead author Dr. P. Patrick Basu told Reuters Health by email.
Dr. Basu, of Columbia University in New York, and colleagues note that resistance to standard treatment regimens has led to PPI, amoxicillin, and clarithromycin triple-therapy cure rates consistently falling below 80%. Other regimens such as those containing metronidazole have also been used, but resistance to that agent has reportedly been as high as 66%.
Newer treatment regimens aimed at eradicating the organism more effectively are increasing in popularity, the researchers say. They conducted an open-label study of the LOAD regimen in 270 patients with H. pylori gastritis or peptic ulcer disease.
Patients were randomized to receive LOAD for seven or 10 days, or be treated with lansoprazole, amoxicillin, and clarithromycin (LAC) therapy for 10 days. Eradication was confirmed by stool antigen testing at least four weeks after cessation of therapy.
Intention-to-treat analysis showed that eradication was higher with LOAD, both with the shorter (90.0%) and longer (88.9%) regimens, than with LAC (73.3%, p<0.05). Adverse events such as headache, nausea, and bloating did not differ between groups.
"A large, randomized controlled clinical trial is warranted to confirm the therapeutic superiority of this regimen," the researchers note.
Dr. Basu added that the cost of LOAD therapy was similar to that of standard 14-day triple drug regimens.
"Considering the compelling data available, LOAD should be considered primary therapy for H. Pylori infection," he said.
SOURCE: http://bit.ly/sDMUNL
Am J Gastroenterol 2011.
This quadruple drug regimen comprised levofloxacin, omeprazole, nitazoxanide, and doxycycline (LOAD). This regimen has a "very high eradication rate" and "virtually negligible" side effects, lead author Dr. P. Patrick Basu told Reuters Health by email.
Dr. Basu, of Columbia University in New York, and colleagues note that resistance to standard treatment regimens has led to PPI, amoxicillin, and clarithromycin triple-therapy cure rates consistently falling below 80%. Other regimens such as those containing metronidazole have also been used, but resistance to that agent has reportedly been as high as 66%.
Newer treatment regimens aimed at eradicating the organism more effectively are increasing in popularity, the researchers say. They conducted an open-label study of the LOAD regimen in 270 patients with H. pylori gastritis or peptic ulcer disease.
Patients were randomized to receive LOAD for seven or 10 days, or be treated with lansoprazole, amoxicillin, and clarithromycin (LAC) therapy for 10 days. Eradication was confirmed by stool antigen testing at least four weeks after cessation of therapy.
Intention-to-treat analysis showed that eradication was higher with LOAD, both with the shorter (90.0%) and longer (88.9%) regimens, than with LAC (73.3%, p<0.05). Adverse events such as headache, nausea, and bloating did not differ between groups.
"A large, randomized controlled clinical trial is warranted to confirm the therapeutic superiority of this regimen," the researchers note.
Dr. Basu added that the cost of LOAD therapy was similar to that of standard 14-day triple drug regimens.
"Considering the compelling data available, LOAD should be considered primary therapy for H. Pylori infection," he said.
SOURCE: http://bit.ly/sDMUNL
Am J Gastroenterol 2011.
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