Supplementing vitamins C and E to standard triple therapy for the eradication of Helicobacter pylori

WHAT IS KNOWN AND OBJECTIVE

Helicobacter pylori eradication rates of currently accepted triple therapy regimens vary between geographic locations and do not exceed 70-80%. Eradication rates are much lower in locations where uncontrolled antibiotic use is common such as Turkey. In the present study, we aimed to test whether supplementing vitamins C and E to standard triple therapy, including a proton pump inhibitor plus amoxicillin plus clarithromycin, increased the H. pylori eradication rate.

METHODS

Two hundred patients infected with H. pylori were randomized into two groups in an open-label trial. In group A, patients (n = 160) were given standard triple therapy, including lansoprazole 30 mg BID plus amoxicillin 1000 mg BID plus clarithromycin 500 mg BID for 14 days, plus vitamin C 500 mg BID plus vitamin E 200 IU BID for 30 days. In group B, patients (n = 40) were given standard triple therapy for 14 days. The success of H. pylori eradication was defined as a negative ¹⁴C-urea breath test result, 4-6 weeks after the completion of therapy. Comaprisons were by both intention-to-treat (ITT) and per-protocol (PP) analysis.

RESULTS AND DISCUSSION

Two hundred patients (137 women, 63 men) were analysed using ITT analysis and 195 patients completed the study. In group A, H. pylori eradication was achieved in 132 of the 160 patients (82·5%) included in ITT analysis and 132 of the 157 patients (84%) included in PP analysis. In group B, H. pylori eradication was achieved in 18 of the 40 patients (45%) included in ITT analysis and 18 of the 38 patients (47·4%) included in PP analysis. Eradication rates were significantly higher in group A than in group B (P < 0·005). Eradication rates were not statistically significant between men and women in both groups.

WHAT IS NEW AND CONCLUSION

Adding vitamins C and E to standard triple therapy increases the eradication rate of H. pylori. Vitamins C and E may increase the eradication rate via increasing the effectiveness of the antibiotics by decreasing oxidative stress in the gastric mucosa and strengthening the immune system.

Application of levofloxacine in the second phase of sequential therapy regimen for Helicobacter pylori eradication: is it a good choice?

AIM

The aim of this study was to evaluate whether modified sequential therapy regimen that consists of an initial phase, including a PPI plus amoxicillin for 5 days followed by a PPI plus only levofloxacin instead of 2 antibiotics for the remaining 5 days increase the eradication rate via decreasing the number and doses of antibiotics, and increasing patient compliance.

METHODS

This study included 40 patients who were admitted to Gastroenterology Outpatient Clinic with H. pylori-positive non-ulcer dyspepsia. All patients received lansoprazole 30 mg BID plus amoxicillin 1,000 mg BID for the first five days followed by lansoprazole 30 mg BID plus levofloxacine 500 mg BID for the remaining five days. Eradication rates were calculated using both intention-to-treat (ITT) and per-protocol (PP) analysis.

RESULTS

In all, 40 patients (21 females, 19 males) were analyzed with ITT analysis and 38 patients completed the study. H.pylori eradication was achieved in 27 (67.5%) of the 40 patients included in the ITT analysis and in 27 (71%) of the 38 patients included in the PP analysis. Mild adverse effects were reported by 8 patients (8.4%). The most frequent side effects were nausea and a metallic taste in the mouth. Any adverse effect that might lead patients to take less than 80% of the prescribed drugs was not reported.

CONCLUSION

This levoflaxin-based sequential therapy regimen was not superior over standard sequential therapy regimen in the eradication of H.pylori. However, it yields better eradication rate than standard triple therapy regimen.