%0 Journal Article %T Hybrid therapy as first-line regimen for Helicobacter pylori eradication in a high clarithromycin resistance area: a prospective open-label trial %+ Paleo Faliro Clinic [Athens] %+ General Hospital of Rhodes %+ Laboratoire de microbiologie médicale = Laboratory of Medical Microbiology [Athènes] %A Georgopoulos, Sotirios, D %A Papastergiou, Vasilios %A Martinez-Gonzalez, Beatriz %A Xirouchakis, Elias %A Familias, Ioannis %A Sgouras, Dionysis %A Mentis, Andreas %A Karatapanis, Stylianos %< avec comité de lecture %@ 1792-7463 %J Annals of Gastroenterology %V 31 %P 1-6 %8 2017 %D 2017 %R 10.20524/aog.2017.0221 %M 29507467 %K Helicobacter pylori %K antibiotic resistance %K clarithromycin %K dual resistance %K hybrid therapy %K metronidazole %Z Life Sciences [q-bio]/Microbiology and Parasitology/BacteriologyJournal articles %X Background: Hybrid therapy is a promising first-line regimen for Helicobacter pylori (H. pylori) eradication. We evaluated a hybrid therapy, assessing the impact of antibiotic resistance on eradication outcome.Methods: This was a prospective study that included 155 treatment-naïve patients diagnosed with H. pylori infection by positive CLO-test, confirmed with histology and/or culture. The hybrid therapy consisted of 40 mg esomeprazole and 1 g amoxicillin for 14 days, with the addition of 500 mg clarithromycin and 500 mg metronidazole for the final 7 days (all b.i.d.). Eradication was defined by negative 13C-urea breath test or histology.Results: The eradication rates were 85.8% (133/155; 95% confidence interval [CI] 79.4-90.5%) by intention-to-treat and 90.2% (129/143; 95%CI 84.1-94.2%) by per-protocol analysis in a setting of high antibiotic resistance (clarithromycin 25.9%, metronidazole 31.1%, dual resistance 8.9%). Adverse events occurred in 29.7% and 1.3% discontinued treatment because of adverse events. Adherence >90% was achieved in 96.6%. The eradication rate in patients with dual clarithromycin/metronidazole resistance (50%) was markedly lower compared to those with single clarithromycin resistance (91.4%), single metronidazole resistance (90.5%) or dual susceptibility (97.8%). Dual resistance was the only factor to correlate with the failure of hybrid therapy (odds ratio 14.4, 95%CI 3.8-54.9, P=0.0003).Conclusions: Hybrid therapy is an effective and safe first-line regimen in populations with relatively high rates of antibiotic resistance. However, dual clarithromycin/metronidazole resistance may significantly compromise its efficacy. %G English %L pasteur-02195966 %U https://riip.hal.science/pasteur-02195966 %~ RIIP %~ RIIP_HELLENIQUE