Prospective Randomised Trial of First and Second Line Treatments of Helicobacter Pylori Infection in Slovenia
Overview
- Phase
- Not Applicable
- Intervention
- Esomeprazole 40mg, Clarithromycin 500 mg, Metronidazole 400 mg,
- Conditions
- Helicobacter Pylori Infection
- Sponsor
- Slovenian Society for Gastroenterology and Hepatology
- Enrollment
- 560
- Locations
- 3
- Primary Endpoint
- Success rate of first line therapy for Helicobacter pylori infection
- Last Updated
- 6 years ago
Overview
Brief Summary
Study is prospective randomised multicentric. The primary objective of the study is to compare the efficacy of two first-line therapy regimens and two second-line therapy regimens (ie, after failure of first-line treatment) in patients with H. pylori infection. The secondary objective of the study is to determine the primary resistance of H. pylori to antibiotics in Slovenia.
Detailed Description
The infection with Helicobacter pylori is extremely widespread, as 60% of the world's population is infected. In Slovenia, the average prevalence is 25.1 %, the prevalence in the 20-year age group is 20 % and 76 % in patients in age group 50 - 75 years. All infected patients have active chronic gastritis, which is asymptomatic in most cases. Ulcers in the stomach or duodenum occurs in 15 % of patients. Due to chronic infection, MALT lymphoma or gastric cancer develop in 1 - 3 % of patients. According to the recommendations of the Slovenian Association for Gastroenterology and Hepatology, as well as European and other recommendations, everyone who is infected with Helicobacter pylori should be treated. H. pylori is a first-class carcinogen and is responsible for 50 % of all chronic cancer-causing infections in the developed world. Therefore, it is necessary to start programs of primary and secondary prevention of gastric cancer by searching and treating infected patients. Patients infected with H. pylori who have not yet been treated will be randomly assigned to two first-line treatment groups: Group 1: Esomeprazole 40 mg, Clarithromycin 500 mg, Amoxicillin 1000 mg, all BID,14 days Group 2: Bismuth subcitrate 120 mg, Amoxicillin 500 mg, Metronidazole 400 mg, all QID Esomeprazole 40 mg BID, 14 days Patients unsuccessfully treated with first-line therapy will be randomly assigned to two second-line treatment groups: Group 1: Esomeprazole 40 mg BID, Levofloxacin 500 mg OID, Amoxicillin 1000 mg BID, 14 days Group 2: Bismuth subcitrate 120 mg, Amoxicillin 500 mg, Metronidazole 400 mg, all QID, Esomeprazole 40 mg BID, 14 days Inclusion criteria : Patients 18 to 80 years of age. Patients have not received proton pump inhibitors for the past 14 days. Patients did not receive antibiotics last month. Helicobacter pylori infection has been demonstrated by rapid urease test Exclusion criteria : Prior treatment for Helicobacter pylori infection (in patients who will receive Schedule 1 eradication therapy). Defects in blood clotting. taking anticoagulant medicines that make it impossible to take biopsies. Drug allergy used in the study. Pregnancy, breastfeeding. Psychiatric illness that would prevent research participation. Active treatment for malignancy. Statistical analysis: To describe the variables, we will use the average value and standard deviation for the symmetrically distributed variables or median and 25th and 75th percentiles for asymmetrically distributed variables. Investigators will use the t-test for dependent variables or, in the case of asymmetrically distributed variables, the Wilcoxon test. To determine the differences between the two groups (Group 1 and Group 2) of the subjects, t-test for independent samples Will be used, or in the case of an asymmetrically distributed variables Mann-Whitney test.
Investigators
Eligibility Criteria
Inclusion Criteria
- Not provided
Exclusion Criteria
- •Prior treatment for Helicobacter pylori infection (in patients who will receive Schedule 1 eradication therapy).•
- •Defects in blood clotting. taking anticoagulant medicines that make it impossible to take biopsies.
- •Allergy to drugs used in the study.
- •Pregnancy, breastfeeding shold be excluded.
- •Psychiatric illness that would prevent research participation.
- •Active treatment for malignancy.
Arms & Interventions
First line therapy for H pylori infection
Tripple 14 day first line therapy Esomeprazole 40 mg, Clarithromycin 500 mg, Amoxicillin 1000 mg, all BID 14 days
Intervention: Esomeprazole 40mg, Clarithromycin 500 mg, Metronidazole 400 mg,
First line therapy for H pylori infection second arm
Bismuth quadruple first line therapy Bismuth subcitrat 120 mg , Amoxicillin 500 mg, Metronidazole 400 mg, all QID, Esomeprazole 40 mg BID, 14 days.
Intervention: Esomeprazole 40mg, Bismuth subcitrate 120 mg, Amoxicillin 500 mg, Metronidazole 400 mg
Second line therapy for H pylori infection
Bismuth quadruple second line therapy for those treated with Tripple first line therapy Bismuth subcitrat 120 mg , Amoxicillin 500 mg, Metronidazole 400 mg, all QID, Esomeprazole 40 mg BID, 14 days.
Intervention: Esomeprazole 40mg, Bismuth subcitrate 120 mg, Amoxicillin 500 mg, Metronidazole 400 mg
Second line therapy for H pylori infection second arm
Tripple second line therapy Esomeprazol 40 mg BID Amoxicillin 1000 mg BID, Levofloxacin 500 mg OID, 14 days or
Intervention: Esomeprazole 40mg, Amoxicillin 500 mg, Levofloxacin 500 mg
Outcomes
Primary Outcomes
Success rate of first line therapy for Helicobacter pylori infection
Time Frame: 2 years
Eradication rate
Success rate of second line therapy for Helicobacter pylori infection
Time Frame: 3 years
Eradication rate
Secondary Outcomes
- Helicobacter pylori resistance rate to antibiotics(3 years)