engleski

How Many H. pylori Positive Patients Can Be Eradicated with Two Consecutive Regimens Proposed by the Maastricht Consensus Rules?

Background: All three Maastricht Consensuses suggest same drags combination for treatment H.pylori infection ; proton pump inhibitor(PPI) and two of three antibiotics: Amoxicillin(A), Clarithromycin(C), Metronidazole(M), and for resistant H.pylori strains quadruple regimen consisting of PPI, Bismuth(B), M and Tetracycline(T).From 1996 we treated our patients according this suggestion. Aim: To calculate H. pylori eradication rates which can be achieved by such two steps of treatment regimens. Methods: 1067 consecutive H.pylori positive patients received first one of three regimens(PPI+C+M, PPI+A+C, PPI+A+M) ; during second treatment we replaced M with C, and vice versa or used quadruple regimen(PPI+B+M+T). Success rate was calculated by intention to treat(ITT) and per protocol(PP) analyses. H.pylori eradication was assessed by histology or UBT. Results: After first treatment 797 patients were eradicated and 18 patients were lost (ITT-74.7%, PP-76, 0% ; ) ; Eradication rate with PPI+M+C was 78, 9%, with PPI+A+C 76, 0%, and with PPI+A+M 74, 1%. Remaining 252 H.pylori+ve patients were treated according above task. Infection was eradicated in 142 patients and 40 patients were lost. (ITT-56, 3%, PP-67, 0%). Eradication was achieved with PPI+M+C in 68, 2%, with PPI+A+C in 69, 9%, with PPI+A+M in 60, 0%, and with PPI+B+M+T in 84, 2%. Summary, from 1067 patients included in treatment we eradicated H.pylori infection in 997 patients, lost from study 58 patients, and 70 patients remained positive (ITT-88, 0% ; PP-93, 4%). Primary resistance to clarithromycin was 8.4 % and for metronidazol 33.5 %. Conclusion: Two consecutive treatments proposed by all three Maastricht consensuses, achieved enough high H.pylori eradication rates in Republic Croatia with still relative low primary resistance to Clarithromycin.

Helicobacter; Maastricht consensus

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