Comparison between different first-line therapy protocols in eradicating in a region with high clarithromycin resistance.

Introduction: infection is encountered in more than 50% of the world population. A high rate of clarithromycin resistance is observed among strains in some regions because clarithromycin is a drug commonly used for the treatment of other infections.

Aim: To identify an efficient eradication protocol for patients infected with and to suggest an alternative first-line therapy particularly in countries with high clarithromycin resistance.

Material And Methods: Patients (18-75 years old) having dyspeptic complaints in a 1-year period and diagnosed with infection by gastric biopsy were included and randomised to three groups, each receiving different sequential eradication therapy (LAM-B: lansoprazole, amoxicillin, metronidazole, bismuth: LAM-T: lansoprazole, amoxicillin, metronidazole, tetracycline; LAM-BT: lansoprazole, amoxicillin, metronidazole, bismuth, tetracycline). Eradication was evaluated via urea breath test.

Results: This study included 166 patients (mean age: 40 ±12 years; female, 68.7%) with infection. Among them, 50 (30.1%) were in the LAM-B group, 59 (35.5%) were in the LAM-T group, and 57 (34.3%) were in the LAM-BT group. The non-steroidal anti-inflammatory drug use was the lowest in the LAM-BT group. Eradication rates were over 80% and similar in each group, with the highest rate in the LAM-BT group (93%). Adverse event rate was the highest in the LAM-T group. eradication was achieved in 143 (86.1%) patients.

Conclusions: The combination regimens without clarithromycin achieved an eradication rate over 80% in all groups. Knowing and monitoring the regional antibiotic resistance rates is important for successful treatment of infections.