A 14 day esomeprazole- and amoxicillin-containing high-dose dual therapy regimen achieves a high eradication rate as first-line anti-Helicobacter pylori treatment in Taiwan: a prospective randomized trial

Background: The first-line eradication rate of standard triple therapy for Helicobacter pylori infection has declined to <80%, and alternative therapies with>90% success rates are needed. Inconsistent eradication rates were reported for proton pump inhibitor- and amoxicillin-containing high-dose dual therapy. Objectives: We performed a prospective, randomized controlled study to assess the efficacy of esomeprazole- and amoxicillin-containing high-dose dual therapy and investigated the influencing clinical factors. Patients and methods: We recruited 240/278 eligible H. pylori-infected patients after exclusion. They were randomly assigned to 14 day high-dose dual therapy (esomeprazole 40mg three times daily and amoxicillin 750mg four times daily for 14 days; EA group) or 7 day non-bismuth quadruple therapy (esomeprazole 40mg twice daily, clarithromycin 500mg twice daily, amoxicillin 1 g twice daily and metronidazole 500mg twice daily for 7 days; EACM group). Urea breath tests were followed up 8 weeks later. Results: The eradication rates for the EA and EACM groups were 91.7% (95% CI=85.3%-96.0%) and 86.7% (95% CI=79.3%-92.2%) (P=0.21) in ITT analysis; and 95.7% (95% CI=90.2%-98.6%) and 92.0% (95% CI=85.4%-96.3%) (P=0.26) in PP analysis. The adverse event rates were 9.6% versus 23.0% in the two groups (P=0.01). The H. pylori culture positivity rate was 91.8%. The antibiotic resistance rates were amoxicillin, 0%; clarithromycin, 14.6%; and metronidazole, 33.7%. Conclusions: A 14 day esomeprazole- and amoxicillin-containing high-dose dual therapy achieves a high eradication rate as first-line anti-H. pylori therapy, comparable to that with 7 day non-bismuth quadruple therapy but with fewer adverse events.