Beta-lactamase inhibition with clavulanic acid supplementing standard amoxycillin-based triple therapy does not increase Helicobacter pylori eradication rate.
BACKGROUND
Antibiotic resistance is the main reason of failure for H. pylori eradication and beta-lactamases produced by resistant H. pylori strains is a possible mechanism underlying ineffectiveness of an amoxycillin-based triple therapy.


OBJECTIVE
To investigate the benefit of using clavulanic acid associated with amoxycillin compared with amoxycillin alone in a standard triple therapy.


METHODS
A total 172 H. pylori-positive dyspeptic patients were randomised to a daily treatment with esomeprazole (20 mg bid), clarithromycin (500 mg bid) and either amoxycillin plus clavulanic acid (1 g bid) or amoxycillin (1 g bid) alone for 1 week. H. pylori status was defined by histology and urea breath test at entry and following 8 weeks from the end of therapy by urea breath test and antigen faecal assessment.


RESULTS
At intention-to-treat and per-protocol analysis eradication rates achieved by amoxycillin plus clavulanic acid (72 and 78%) were higher, but not significantly, than those achieved by amoxycillin alone triple therapy (62 and 72%). Compliance was good, side-effects mild and with a similar incidence in both regimens.


CONCLUSIONS
Clavulanic acid supplemented to amoxycillin-based standard triple therapy does not significantly increase the H. pylori eradication rate with standard triple therapy.
Crispino
P
P
Gastroenterology Unit, Department of Clinical Sciences, Policlinico Umberto I, Viale del Policlinico 157, 00161 Rome, Italy.
Iacopini
F
F
Pica
R
R
Consolazio
A
A
Bella
A
A
Cassieri
C
C
Nardi
F
F
Paoluzi
P
P
D000658:Amoxicillin / Q000627:therapeutic use*; D019818:Clavulanic Acid / Q000494:pharmacology / Q000627:therapeutic use*; D004791:Enzyme Inhibitors / Q000494:pharmacology / Q000627:therapeutic use*; D005243:Feces / Q000382:microbiology; D005260:Female; D016481:Helicobacter Infections / Q000188:drug therapy*; D016480:Helicobacter pylori / Q000187:drug effects / Q000201:enzymology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D001618:beta-Lactamases / Q000378:metabolism*
D004791:Enzyme Inhibitors; D019818:Clavulanic Acid; D000658:Amoxicillin; D001618:beta-Lactamases