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The following is a summary of “Clinical Impact of High-dose Esomeprazole-amoxicillin Dual Therapy as Rescue Treatment for Helicobacter pylori Infection: A Prospective, Multicenter, Randomized Trial,” published in the November 2024 issue of Gastroenterology by Wang et al.

Helicobacter pylori (H. pylori) infection is often treated with various regimens, but some patients fail to respond to standard therapies.   

Researchers conducted a prospective study to compare high-dose dual therapy (esomeprazole-amoxicillin) and furazolidone-based quadruple therapy (FBQT) in nonresponsive patients with H. pylori.   

They assigned 209 patients with H. pylori infection, who had prior treatment failures, to high-dose dual therapy (HDDT; esomeprazole 40 mg, amoxicillin 1 g twice daily for 14 days) or (FBQT; 14-day regimen) groups. Success rates and safety were evaluated for 4 weeks posttreatment using intention-to-treat (ITT) and per-protocol (PP) analyses.   

The results showed after 14 days of treatment, H. pylori eradication rates were 93.6% in the HDDT group and 86.9% in the FBQT group (ITT). In the PP analysis, eradication rates were 94.5% for HDDT and 88.7% for FBQT. No significant difference was found between the groups in eradication rates; HDDT had significantly fewer adverse reactions (9.1% in ITT, 9.2% in PP) compared to FBQT (58.6% in ITT, 59.8% in PP). Multivariate analysis identified interval time, alkaline phosphatase, and serum creatinine levels influencing eradication success. The optimal intervals for salvage treatments were 6 months for FBQT and 1 year for HDDT.        

They concluded that HDDT using esomeprazole and amoxicillin was an effective, well-tolerated rescue treatment for H. pylori, offering reduced side effects compared to FBQT.   

Source: journals.lww.com/jcge/fulltext/9900/clinical_impact_of_high_dose.375.aspx