: High dose amoxicillin does not improve primary or secondary eradication rates in an Irish cohort.

Background: () eradication rates have fallen globally, likely in large part due to increasing antibiotic resistance to traditional therapy. In areas of high clarithromycin and metronidazole resistance such as ours, Maastricht VI guidelines suggest high dose amoxicillin dual therapy (HDADT) can be considered, subject to evidence for local efficacy. In this study we assess efficacy of HDADT therapy for eradication in an Irish cohort.

Aim: To assess the efficacy of HDADT therapy for eradication in an Irish cohort as both first line, and subsequent therapy for patients diagnosed with .

Methods: All patients testing positive for in a tertiary centre were treated prospectively with HDADT (amoxicillin 1 g and esomeprazole 40 mg × 14 d) over a period of 8 months. Eradication was confirmed with Urea Breath Test at least 4 wk after cessation of therapy. A delta-over-baseline > 4% was considered positive. Patient demographics and treatment outcomes were recorded, analysed and controlled for basic demographics and prior treatment.

Results: One hundred and ninety-eight patients were identified with infection, 10 patients were excluded due to penicillin allergy and 38 patients refused follow up testing. In all 139 were included in the analysis, 55% ( = 76) were female, mean age was 46.6 years. Overall, 93 (67%) of patients were treatment-naïve and 46 (33%) had received at least one previous course of treatment. The groups were statistically similar. Self-reported compliance with HDADT was 97%, mild side-effects occurred in 7%. There were no serious adverse drug reactions. Overall the eradication rate for our cohort was 56% (78/139). Eradication rates were worse for those with previous treatment [43% (20/46) 62% (58/93), = 0.0458, odds ratio = 2.15]. Age and Gender had no effect on eradication status.

Conclusion: Overall eradication rates with HDADT were disappointing. Despite being a simple and possibly better tolerated regime, these results do not support its routine use in a high dual resistance country. Further investigation of other regimens to achieve the > 90% eradication target is needed.