Bacterial Infection Due to Helicobacter Pylori (H. Pylori) Clinical Trial
Official title:
Increased Second-line Eradication Rate of Helicobacter Pylori by Adding N-acetylcystein or Metronidazole to the Conventional Triple Therapy.
Compare efficacy and safety of 10-day triple therapy (rabeprazole, clarithromycin and amoxicillin) plus N-acetylcystein versus 10-day concomitant therapy (rabeprazole, clarithromycin, amoxicillin and metronidazole) for re-eradication for gastric Helicobacter pylori infection.
Background: Antimicrobial resistance has decreased the eradication rates of common used
triple therapy for Helicobacter pylori infection (less than 80%). Such treatment for patient
previously with treatment failure, the retreatment eradication rate is less then 50%. Some
studies showed the Helicobacter pylori form biofilm to prevent entry of antibiotics, and the
N-acetylcystein is helpful to dissolve the biofilm.
Objective: To determine the eradication rate of the common used triple therapy after adding
N-acetylcystein for second line treatment for adults infected with Helicobacter pylori in
Eastern Taiwan.
Design: Randomized, open-label, prospective controlled trial.
Patients: who are previously failed the primary treatment for eradication and still infected
by Helicobacter pylori.
Measurements: 13C-urea breath test, upper endoscopy, histologic evaluation, rapid urease
test, bacterial culture, assessment of antibiotic resistance and CYP2C19 genotype of host.
Intervention: patients with Helicobacter pylori eradication treatment failure are recruited
and randomly assigned to receive one of the following therapeutic schemes: 1) study group:
rabeprazole 20mg bid + amoxicillin 1g bid + clarithromycin 0.5g bid + N-acetylcystein 0.6g
bid for 10 days; 2) control group: rabeprazole 20mg bid + amoxicillin 1g bid +
clarithromycin 0.5g bid + metronidazole 0.5g bid for 10 days. Repeat upper endoscopy for
histologic evaluation, rapid urease test or 13C-urea breath test after 4 week of treatment
to assess the treatment result. The influence on the hybrid therapies of antibiotic
resistance of Helicobacter pylori and CYP2C19 genotype of host were determined.
Expected results: The new second line treatment for eradication of Helicobacter pylori is
effective, and to determine the relation of antibiotic resistance of Helicobacter pylori and
CYP2C19 genotype of host to the treatment result.
;
Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment
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