title: An optimized clarithromycin-free 14-day triple therapy for Helicobacter pylori eradication achieves high cure rates in Uruguay.
abstract: BACKGROUND
  Strong acid inhibition increases cure rates with triple therapy and 14-day are more effective than 7-day treatments. The combination of amoxicillin plus metronidazole at full doses has been shown to overcome metronidazole resistance and to achieve good eradication rates even in patients harboring resistant strains. No previous studies have been reported in Latin-America with this optimized triple-therapy scheme.
  
  
  OBJECTIVE
  The aim of the present study was to assess the eradication rate and tolerance of a new first-line treatment regimen associating strong acid inhibition, amoxicillin and metronidazole.
  
  
  METHODS
  Patients from the Clínica de Gastroenterología of the Hospital de Clínicas (Montevideo, Uruguay) were included. Hp status was mainly assessed by at least one of the following: histologyor urea breath test (UBT). A 14-day treatment was prescribed comprising esomeprazole 40mg twice a day plus amoxicillin 1g and metronidazole 500mg, both three times a day. H. pylori cure was assessed by UBT.
  
  
  RESULTS
  Forty-one patients were enrolled. Mean age was 53.3±13 years and 17.1% of patients were male. Main indications for treatment were: functional dyspepsia (27.5%), gastritis (45%), gastric or duodenal erosions (20%), gastric ulcer (5%) and intestinal metaplasia (2.5%). H. pylori eradication was achieved in 33 of the 37 patients who returned for follow-up. Eradication rates were 80.5% (95% CI: 68.4-92.6) by intention-to-treat (ITT) analysis and 89.2% (95% CI; 79.2-99.2) per protocol (PP). No major side effects were reported; 26 patients (65.8%) complained of mild side effects (nausea, diarrhea and headache).
  
  
  CONCLUSIONS
  Cure rates of this triple therapy including esomeprazole, amoxicillin and metronidazole were 81% per ITT and the treatment was well tolerated. These optimal results with a simple clarithromycin-free triple therapy are better than described for standard triple therapy but there is still room for improvement to reach the desired target of 90% per ITT.
authors.affiliation: Clínica de Gastroenterología, Hospital de Clínicas, Facultad de Medicina, UdelaR, Montevideo, Uruguay.
authors.forename: Cristina
authors.initials: C
authors.lastname: Dacoll
authors.affiliation: Unitat de Malalties Digestives, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Departament de Medicina, Universitat Autònoma de Barcelona, Grupo de Investigación Consolidado AGAUR (SGR01500), Sabadell, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Spain. Electronic address: jsanchezd@tauli.cat.
authors.forename: Jordi
authors.initials: J
authors.lastname: Sánchez-Delgado
authors.affiliation: Laboratorio de Referencia, Montevideo, Uruguay.
authors.forename: Henia
authors.initials: H
authors.lastname: Balter
authors.affiliation: Clínica de Gastroenterología, Hospital de Clínicas, Facultad de Medicina, UdelaR, Montevideo, Uruguay.
authors.forename: Ximena
authors.initials: X
authors.lastname: Pazos
authors.affiliation: Clínica de Gastroenterología, Hospital de Clínicas, Facultad de Medicina, UdelaR, Montevideo, Uruguay.
authors.forename: María
authors.initials: M
authors.lastname: Di Pace
authors.affiliation: Clínica de Gastroenterología, Hospital de Clínicas, Facultad de Medicina, UdelaR, Montevideo, Uruguay.
authors.forename: Gabriela
authors.initials: G
authors.lastname: Sandoya
authors.affiliation: Clínica de Gastroenterología, Hospital de Clínicas, Facultad de Medicina, UdelaR, Montevideo, Uruguay.
authors.forename: Henry
authors.initials: H
authors.lastname: Cohen
authors.affiliation: Unitat de Malalties Digestives, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Departament de Medicina, Universitat Autònoma de Barcelona, Grupo de Investigación Consolidado AGAUR (SGR01500), Sabadell, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Spain.
authors.forename: Xavier
authors.initials: X
authors.lastname: Calvet
keywords: Clarithromycin-free; Dosis altas; Eradication; Erradicación; Helicobacter; High doses; Latin America; Latinoamérica; Sin claritromicina; Tratamiento; Treatment; Uruguay