title: Effect of IL-1 Polymorphisms, CYP2C19 Genotype and Antibiotic Resistance on Helicobacter pylori Eradication Comparing Between 10-day Sequential Therapy and 14-day Standard Triple Therapy with Four-Times-Daily-Dosing of Amoxicillin in Thailand: a Prospective Randomized Study.
abstract: BACKGROUND
  Studies of effects of IL-1 polymorphisms, CYP2C19 genotype together with antibiotic resistance for H. pylori eradication are rare worldwide. The present study was designed to evaluate efficacy of 10-day sequential therapy (SQT) and 14-day standard triple therapy (STT) with four- times-daily dosing of amoxicillin for H. pylori eradication related to these important host and bacterial factors in Thailand.
  
  
  METHODS
  This prospective randomized study was performed during March 2015 to January 2016. H. pylori infected gastritis patients were randomized to receive 10-day sequential therapy and 14-day standard triple therapy. CYP2C19 genotyping, IL1 polymorphism (IL-1B and IL-1RN genotypes) and antibiotic susceptibility tests were performed in all patients. 13C-UBT was conducted to confirm H. pylori eradication at least 4 weeks after treatment.
  
  
  RESULTS
  A total of 100 patients (33 males and 67 females, mean age=51.1 years) were enrolled. Eradication rate by PP analysis was 97.9% (47/48) with the 10-day SQT regimen and 87.8% (43/49) with 14-day STT regimen (97.9% vs 87.8%; p-value=0.053). Antibiotic susceptibility testing demonstrated 45% resistance to metronidazole, 14.8% to clarithromycin, and 24.1% to levofloxacin. CYP2C19 genotyping revealed 44.9% RM, 49% IM and 6.1% PM. IL-1B and IL-1RN genotypes were demonstrated as 21.4% for CC, 48.1% for TC, 36.8% for TT, 72.7% for 1/1, and 21.2% for 1/2 genotypes, respectively. The 10-day SQT regimen provided 100% eradication in patients with clarithromycin or dual clarithromycin and levofloxacin H. pylori resistant strains. Moreover, the 10-day SQT regimen resulted in a 100% eradication rate in all patients with CYP2C19 genotype RM and almost type of IL-1B (TC and TT) and IL1-RN genotypes ( 1/2 and other).
  
  
  CONCLUSIONS
  Treatment with 10-day sequential therapy is highly effective for H. pylori eradication regardless of the effects of clarithromycin resistance, dual clarithromycin and levofloxacin resistance, CYP2C19 genotype, IL-1B and IL1-RN genetic polymorphisms and can be used as effective first line therapy in Thailand.
authors.affiliation: Gastroenterology Unit, Thammasat University Hospital, Pathumthani, Thailand E-mail : Vilaichone@hotmail.co.th.
authors.forename: Kittichet
authors.initials: K
authors.lastname: Phiphatpatthamaamphan
authors.forename: Ratha-Korn
authors.initials: RK
authors.lastname: Vilaichone
authors.forename: Sith
authors.initials: S
authors.lastname: Siramolpiwat
authors.forename: Anupong
authors.initials: A
authors.lastname: Tangaroonsanti
authors.forename: Soonthorn
authors.initials: S
authors.lastname: Chonprasertsuk
authors.forename: Patommatat
authors.initials: P
authors.lastname: Bhanthumkomol
authors.forename: Bubpha
authors.initials: B
authors.lastname: Pornthisarn
authors.forename: Varocha
authors.initials: V
authors.lastname: Mahachai
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000658:Amoxicillin / Q000008:administration & dosage*; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D017291:Clarithromycin / Q000008:administration & dosage; D065731:Cytochrome P-450 CYP2C19 / Q000235:genetics*; D004334:Drug Administration Schedule; D004352:Drug Resistance, Microbial / Q000235:genetics*; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D016481:Helicobacter Infections / Q000235:genetics / Q000382:microbiology / Q000517:prevention & control*; D016480:Helicobacter pylori / Q000235:genetics / Q000472:pathogenicity; D006801:Humans; D007375:Interleukin-1 / Q000235:genetics*; D008297:Male; D008795:Metronidazole / Q000008:administration & dosage; D008875:Middle Aged; D011110:Polymorphism, Genetic / Q000235:genetics*; D011379:Prognosis; D011446:Prospective Studies; D064750:Rabeprazole / Q000008:administration & dosage; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D007375:Interleukin-1; D008795:Metronidazole; D064750:Rabeprazole; D000658:Amoxicillin; C045793:CYP2C19 protein, human; D065731:Cytochrome P-450 CYP2C19; D017291:Clarithromycin