engleski

Should the National strategy for the first-line treatment of H. pylori infection be changed?

Background: Randomized controlled trials (RCT) and meta analyses have shown, in countries with primary resistance of H. pylori to clarithromycin higher than 20%, the Sequential treatment as the first-line therapy to be superior in efficacy than classic triple therapy. Aim: To evaluate whether the National Strategy for the first-line treatment of H. pylori infection in the Republic of Croatia should be changed. Methods: In a period between 2008 and 2010, at the Croatian Reference Centre for H. pylori infections, covering the northern and western areas of Croatia, 269 patients were treated by 10-days triple therapy (128 by IPP-A-Cl ; 141 by IPP-M-Cl). Primary resistance to macrolides was 23, 9% and to metronidazole - 37, 9%. In a period between 2011 and 2013, 53 patients were treated with sequential therapy. Primary resistance to macrolides over this period was nearly similar - 22.2%, and 37, 9% to metronidazole. Results: Success of triple therapy in the first period was unsatisfactory: IPP-A-C: 103/128=80, 5%: IPP-A-M: 110/141=78% (PP analysis). The success of sequential treatment in the last period was 50/53=94, 3% (PP analysis), which was statistically significantly higher than in the previous period (IPP-A-C vs Sequential p<0.02 ; IPP-A-M vs Sequential p<0.01). Similar results were achieved at another Centre covering the area of south Croatia. Conclusion: The Croatian Consensus Conference on H. pylori infection was held at the beginning of 2013. In our opinion, the results stated above and literature data lend support to our conclusion that, in the absence of culture results, Sequential therapy should be used as the standard first-line treatment for H. pylori infection in our country. :

national strategy; sequential therapy; triple therapy

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