Om epr azole, am ox icillin, clarithr omycin H elicobacter p y lori

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1 : Om epr azole, am ox icillin, clarithr omycin H elicobacter p y lori, =A b s t r a c t s = T he e f f e ct of He lic obac te r p y lo ri eradic ation of triple therapy w ith ome prazole, am ox ic illin an d clarithromy c in In Seop Jung, M.D., Su Jin Hong, M.D., Jin Oh Kim, M.D., Joo Young Cho, M.D., Moon Sung Lee, M.D. and Chan Sup Shim, M.D. Institiute f or Digestive R esearch, Department of Internal M edicine Soon Chun Hyang University College of M edicine, Seoul, K orea B ackg roud : T oday, the eradication of H. pylori represents a generally accepted and beneficial therapeutic strategy for treatment and prevention of peptic ulcer relapse. Major factors that have affected H. pylori eradication are eradication rate of regimen, compliance of patients and complications of drugs. Recently, the combination of omeprazole, amoxicillin and clarithromycin has been accepted as one of the most effective treatment for the eradication of H. pylori. The primary aim of this study was to evaluate the efficacy of this therapeutic modality in Korean patients. Meth ods : Two hundred twenty three patients with peptic ulcer and H. pylori infection were taken two types of triple therapy. Group A were treated with omeprazole 20 mg bid, amoxicillin 500 mg tid, clarithromycin 500 mg tid daily for 14 days. Group B were treated with omeprazole 20 mg bid, amoxicillin 1g bid, clarithromycin 500 mg bid daily for 7 days. Endoscopy with H. pylori tests was repeated 4 weeks after the end of treatment and then biopsy specimens were taken in antrum and body. CLO test and Warthin Starry silver stain were conducted concordantly. Re s ult s : T he H. pylori eradication rate was 92.5% in group A, 90.4% in group B. There was no significant difference in eradication rate. More than 50% of ulcer size reduction was observed 90.5% in group A, 86.3% in group B. There was no significant difference in ulcer healing(p > 0.05). T he incidence of all side effects in both group were as follows; 22.6% in group A, 19.1% in group B. But major side effect was found only group A, of whom the symptom was too serious for the treatment to continue. Conclus ion : We concluded that the seven days regimen was more favorable, because the eradication rate was almost the same as the 14 days regimen. And drug compliance and cost effectiveness were better than 14 days treatment regimen.(korean J Med 58: , 2000) Key W ords : H elicobacter pylori; Omeprazole; Amoxicillin; Clarithromycin : : :, 657, ( ) E - mail :

2 In Seop Jung, et al : The effect of Helicobacter pylori eradication of triple therapy with omeprazole, amoxicillin and clarithromycin H elicobacter pylori( H. pylori) 90 95%, 60 80% 1, 2 ), H. pylori. H. pylori,. H. pylori omeprazole, amoxicillin, clarithromycin ). H. pylori 223 omeprazole amoxicillin clarithromycin H. pylori H. pylori,, ) H. pylori 2 CLO, Wharthin- Starry, H. pylori. 2). A omeprazole 20 mg 1 2, amoxicillin 500 mg 1 3, clarithromycin 500 mg B omeprazole 20 mg 1 2, amoxicillin 1 g 1 2, clarithromycin 500 mg ) 1, 2. H. pylori 4 0.6cm size marker, 2 CLO Wharthin- Starry. 3. H. pylori,, Chi- squre p Omeprazole 20 mg 1 2, amoxicillin 500 mg 1 3, clarithromycin 500 mg A , 40, 49.2, 87, 36, 27. Omeprazole 20 mg 1 2, amoxicillin 1 g 1 2, clarithromycin 500 mg B 73 57, 16, , 23, 15,, (T able 1). 2. H. pylori A (92.5%) H. pylori

3 : T able 1. Clinic al characteris tic s of patients. B (90.4%) H. pylori (p >0.05)(T able 2). 3. Group A Group B Age (years) Sex (M/ F) 110/ 40 57/ 16 Smoking history (yes/ no) 98/ 52 49/ 24 Drinking history (yes/ no) 72/ 78 35/ 38 DU (n) GU (n) DU + GU (n) T otal (n) DU ; duodenal ulcer, GU ; gastric ulcer Group A ; treated with omeprazole 20mg bid, amoxicillin 500 mg tid, clarithromycin 500 mg tid daily for 14 days. Group B ; treated with omeprazole 20 mg bid, amoxicillin 1g bid, clarithromycin 500 mg bid daily for 7 days. 4 50% A (95.3%), (85.7%), (80.7%) (90.7%) 50%, B (91.4%), (82.6%), (80.0%) (86.3%) 50% (p >0.05) (T able 3). 4.,,,,,,. A 150 2, 1 3, 31 (20.6%) 22.6%. B %., 3 A (T able 4). 5. Omeprazole 1 capsule 2,032, amoxicillin 1 capsule 40, clarithromycin 1 tablet 1,766 A 208,600, B 80,136 T able 2. Eradication rate of H. p ylori Group T otal No. of Eradicated Patient Eradication Rate(%) Group A 147 * Group B * 3 patients were dropped out. p > 0.05 T able 3. Ev aluation of ulcer healing : Comparis on of the endoscopic finding betw een initial diag nosis and 4 w eeks after the triple therapy. Cases that the ulcer size w as less than 50 % of initial pre - treated ulcer size. T otal DU GU DU + GU Group A 134 / / / / 26 (90.5%) (95.3%) (85.7%) (80.7%) Group B 63 / / / / 15 DU ; duodenal ulcer, GU ; gastric ulcer p >0.05 (86.3%) (91.4%) (82.6%) (80.0%)

4 5 : Omeprazole, amoxicillin, clarithromycin H elicobacter pylori T able 4. Side effects in each treatment g roup Group A (n=150) Group B (n=73) Major side effects * 3 (2%) 0 (0%) Nausea/ Vomiting 2 0 Abdominal distention 1 0 Minor side effects 31 (20.6%) 14 (19.1%) Metallic taste 8 4 Nausea/ Vomiting 6 4 Diarrhea 7 1 Soreness 6 3 Epigastric discomfort 4 2 T otal 34 (22.6%) 14 (19.1%) Major side effects * ; T he side effects wherein the symptom is too serious for the treatment to be continued. Minor side effects ; T he side effects wherein the symptom is not so serious that the treatment can be continued. T able 5. Cost of each drug and each treatment (w on ) Omeprazole 2,032 / C Amoxicillin 40 / C Clarithromycin 1,766 / C Group A 208,600 Group B 80,136 B (T able 5) Warren Marshall H. pylori 6 ),,. H. pylori,, 7, 8 ). H. pylori ph,,,,,,,,, 9 ). H. pylori 1980 bismuth, metronidazole, amoxicillin, tetracycline, clarithromycin, proton pump inhibitor H2. H. pylori proton pump inhibitor H. pylori.. 20%, 40 80%, 80 90%. 80% ). bismuth metronidazole tetracycline amoxicillin 2 13) H. pylori 90%, metronidazole 87.5% metronidazole, metronidazole

5 Korean Journal of Medicine : Vol. 58, No. 6, % 14 ). metronidazole clarithromycin clarithromycin. Clarithromycin macrolide,, omeprazole, amoxicillin, clarithromycin. 1 4 PPI. H. pylori. 2 CLO Wharthin- Starry. H. pylori.,,.,,,,,,, H. pylori 15 ). 223 omeprazole, amoxicillin, clarithromycin 2 1 H. pylori,,,. H. pylori omeprazole, amoxicillin, clarithromycin 2 A 92.5% 1 B 90.4%. Moayyedi 16 ) OAC 1 2. A 22.6% B 19.1%, A % A 90.5%, B 86.3% A. A 208,600, B 80,136 B. H. pylori. 12 ).,,,, 17 ). 90% omeprazole, amoxicillin, clarithriomycin 1 H. pylori. : H. pylori H. pylori. omeprazole amoxicillin clarithromycin, 2 H. pylori. : H. pylori 223 A omeprazole

6 In Seop Jung, et al : The effect of Helicobacter pylori eradication of triple therapy with omeprazole, amoxicillin and clarithromycin mg 1 2, amoxicillin 500 mg 1 3, clarithromycin 500 mg B omeprazole 20 mg 1 2, amoxicillin 1 g 1 2, clarithromycin 500 mg , 2. H. pylori 4 CLO Wharthin- Starry. : A , 36, 27. B 73 35, 23, 15. H. pylori A %. B %. 4 50% A 134 (90.5%), B 63 (86.3%). A 3, B. 2, 1. : Omeprazole, amoxicillin, clarithromycin H. pylori R E F E R E N C E S 1) Blaster MJ. Gastric Campylobacter- like organisms, gastritis, and p ep tic ulcer disease. Gastroenterology 93: , ) Dooley CP, Cohen H. The clinical significance of Cam - pylobacter pylori. A nn Intern M ed 108:70-79, ) Graham DY, Lew GM, Malaty HM, Evans DG, Evans DJ Jr, Klein PD, Alpert LC, Gesta RMl. Factors inf luencing the eradication of Helicobacter pylori with trip le therapy. Gastroenterology 102: , ) Glupczynski Y, Burette A. D rug therapy for H elicobacter pylori inf ection: p roblems and p itfalls. A m J Gastroenterol 85: , ) Cutler AF, Schubert TT. Patient factors affecting H elicobacter pylori eradication with trip le therapy. A m J Gastroenterol 88: , ) Warren JR, Marshall BJ. Unidentified curved bacilli in gastric ep ithelium in active chronic gastritis. Lancet 1: , ) O'Brien B, Goeree R, Hafeez M, Hunt R. Cost eff ectiveness of H elicobacter pylori eradication f or the long term managem ent of duodenal ulcer in Canada. A rch Intern M ed 155: , ) Unge P, Jonsson B, Stalhammar N- O. The cost eff ectiveness of H elicobacter pylori eradication versus maintenance and ep isodic treatment in duodenal ulcer patients in Sweden. Pharmacoeconomics 8:410, ) Graham DY, Smith JL, Bouvet AA. What happ ens to tablets and capsules in the stomach? Endoscop ic comparison of disintegration and disp ersion characteristics of two microencapsulated p otassium f ormulations. J Pharm Sic 79: , ) Treiber G. The inf luence of drug dosage on H elicobacter pylori eradication: a costeff ectiveness analysis. A m J Gastroenterol 91: , ) Vakil N. The economics of eradicating H elicobacter pylori inf ection in duodenal ulcer disease. A m J M ed 100:S60- S63, ) Vakil N, Fennerty MB. Cost- effectiveness of treatment regimens f or the eradication of H elicobacter pylori in duodenal ulcer. A m J Gastroenterol 91: , ) Isenberg JI, McQuaid KR, Laine L, Walsh JH. A cid-p ep tic disorders. In: Yamada T, ed. T extbook of gastroenterology. Volume 1. 2nd ed. p. 1392, Philadelphia, JB L ipp incott, ),,. H elicobacter pylori metronidazole metronidazole. 28(Supp l 2):58, ) Borody TJ, Brandl S, Andrews P, Ferch N, Jankiewicz E, Hyland L. Use of high eff icacy, lower dose trip le therapy to reduce side eff ects of eradicating H elicobacter pylori. A m J Gastroenterol 89:33-38, ) Moayyedi P, Langworthy H, Shanaban K, T ompkins DS, Dixon MF, Chalmers DM, Axon AT. Comparison of one or two weeks of lansop raz ole, amoxicillin and clarithromycin in the treatment of H elicobacter pylori. H elicobacter 1:71-74, ) Graham DY. A reliable cure f or H elicobacter pylori inf ection? Gut 37: ,