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Beta-lactamase inhibitors increase the level of eradication of H. pylori

The use of triple therapy (a combination of a drug that suppresses the secretion of hydrochloric acid and two antibacterial agents) for a week is the gold standard in the treatment of infections caused by H. pylori . Recently, there has been a tendency to increase the resistance of pathogens to conventional triple therapy. Recently, it has been noted that the combination of amoxicillin and clavulanic acid is somewhat more effective than the use of amoxicillin alone, and that β-lactamase inhibitors have antibacterial activity against H. pylori in vitro.

An open randomized study compared the efficacy of two treatment regimens for H. pylori infection: omeprazole + clarithromycin + amoxicillin / clavulanate versus the standard regimen (omeprazole + clarithromycin + amoxicillin). Both regimens were prescribed for 1 week.

The study involved 60 patients (36 men, 24 women; average age 53 ± 9 years) suffering from dyspeptic disorders and an infection associated with H. pylori not previously treated. Patients were randomly given either 875 mg of amoxicillin and 125 mg x twice daily of clavulanic acid, 500 mg x twice daily of clarithromycin, 20 mg x twice daily of omeprazole (ACCO, n = 30), i.e. 1 gx 2 times of amoxicillin. per day, clarithromycin 500 mg x 2 times a day, omeprazole 20 mg x 2 times a day (AKO, n = 30).

After 4 to 6 weeks, the eradication of H. pylori was assessed using a C-urease breath test. Data on the dynamics of gastrointestinal symptoms and side effects during antibiotic therapy were obtained using special questionnaires.

All patients completed the study. The eradication level of H. pylori was significantly higher in the AKCO group than in the AKO group: 86.6% (26/30) vs 66.6 % (20/30), respectively (p less than 0.05). During the study, insignificant adverse drug reactions (NLR) were recorded in 8% of patients, however, there were no significant differences in the nature of NLR and the frequency of their occurrence between the two. groups. No serious adverse events were observed during the study.

According to the results of this study, the combination of amoxicillin / clavulanate in combination with clarithromycin and omeprazole showed a higher eradication level of H. pylori compared to amoxicillin and to the above drugs without increasing the incidence of NLR. Thus, the use of amoxicillin / clavulanate may be an alternative to amoxicillin in conventional treatment regimens for an infection associated with H. pylori.