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Vonoprazan improves the efficacy of Helicobacter pylori eradication therapy with a regimen consisting of clarithromycin and metronidazole in patients allergic to penicillin

2017; Wiley; Volume: 22; Issue: 3 Linguagem: Inglês

10.1111/hel.12374

1523-5378

Shoko Ono, Mototsugu Kato, Soichi Nakagawa, Katsuhiro Mabe, Naoya Sakamoto,

Eosinophilic Esophagitis

Abstract Background Although all Helicobacter pylori ( H. pylori )‐positive patients should receive eradication therapy, the therapy is a challenge for patients allergic to penicillin. There have been a few reports on the efficacy of eradication therapy for such patients. Objective To analyze the efficacy of vonoprazan or proton pump inhibitor ( PPI )‐based 7‐day triple therapy in patients allergic to penicillin. Materials and Methods A total of 88 consecutive patients allergic to penicillin who received H. pylori eradication therapy were retrospectively analyzed. Thirty‐one patients had a history of failed eradication therapy. Four 7‐day regimens were prescribed during the study period: clarithromycin‐metronidazole‐ PPI (13 patients), clarithromycin‐metronidazole‐vonoprazan (14 patients), metronidazole‐sitafloxacin‐ PPI (44 patients) and metronidazole‐sitafloxacin‐vonoprazan (17 patients). A 13 C‐urea breath test was used for confirmation of eradication, and efficacy of eradication was evaluated by “intention‐to‐treat” analysis and “per‐protocol” analysis. Results Intention‐to‐treat and per‐protocol eradication rates were 46.2%/54.6% for patients who received clarithromycin‐metronidazole‐ PPI , 92.9/92.9% for patients who received clarithromycin‐metronidazole‐vonoprazan, 100/100% for patients who received metronidazole‐sitafloxacin‐ PPI and 88.2/93.8% for patients who received metronidazole‐sitafloxacin‐vonoprazan. For first eradication, vonoprazan significantly raised the intention‐to‐treat efficacy of the triple therapy including clarithromycin‐metronidazole (vonoprazan: 92.9%, PPI : 46.2%, P =.0128). A 7‐day regimen consisting of metronidazole and sitafloxacin was effective for patients allergic to penicillin with or without past failure of eradication. Conclusion For first eradication in patients allergic to penicillin, a 7‐day triple therapy consisting of clarithromycin, metronidazole and vonoprazan could be a candidate eradication regimen.