Clarithromycin resistance, but not CYP2C-19 polymorphism, has a major impact on treatment success in 7-day treatment regimen for cure of H. pylori infection: a multiple logistic regression analysis

Dig Dis Sci. 2001 Nov;46(11):2445-50. doi: 10.1023/a:1012371702918.

Abstract

Mutations in the gene encoding the CYP2C-19 enzyme for PPI metabolism have been shown to enhance the chance for a cure in a H. pylori-positive patients using a two-week dual-therapy regimen involving omeprazole and amoxicillin. However, the impact of CYP2C-19 genetic polymorphism on eradication rates of a one-week triple-therapy regimen has not been examined. In this cohort study, 156 H. pylori-positive peptic ulcer or NUD patients who presented to our university hospital were recruited. They were treated by one-week omeprazole-amoxicillin-clarithromycin therapy. Host and bacterial predictive factors including H. pylori susceptibility and CYP2C-19 genotyping, as well as cure rate for H. pylori infection, were studied. Cure rate was 85.9% (95% CI: 79-91%) on an intent to treat (ITT) basis. By multiple logistic regression analysis, only clarithromycin resistance had a significant impact on treatment success (odds ratio 28.7: 95% CI: 6-172). CYP2C-19 genetic polymorphism was not associated with a significant change in cure rate. These observations indicate only clarithromycin susceptibility, not CYP2C-19 polymorphism, has a major impact on the treatment success when using a seven-day OAC H. pylori treatment regimen.

MeSH terms

  • Amoxicillin / therapeutic use
  • Anti-Bacterial Agents / therapeutic use
  • Aryl Hydrocarbon Hydroxylases*
  • Clarithromycin / pharmacology*
  • Clarithromycin / therapeutic use
  • Cytochrome P-450 CYP2C19
  • Cytochrome P-450 Enzyme System / genetics*
  • Drug Resistance, Bacterial
  • Drug Therapy, Combination
  • Dyspepsia / microbiology
  • Female
  • Helicobacter Infections / drug therapy*
  • Helicobacter pylori* / drug effects
  • Humans
  • Logistic Models
  • Male
  • Middle Aged
  • Mixed Function Oxygenases / genetics*
  • Omeprazole / therapeutic use
  • Penicillins / therapeutic use
  • Peptic Ulcer / microbiology
  • Polymorphism, Genetic
  • Prospective Studies
  • Proton Pump Inhibitors
  • Time Factors
  • Treatment Outcome

Substances

  • Anti-Bacterial Agents
  • Penicillins
  • Proton Pump Inhibitors
  • Amoxicillin
  • Cytochrome P-450 Enzyme System
  • Mixed Function Oxygenases
  • Aryl Hydrocarbon Hydroxylases
  • CYP2C19 protein, human
  • Cytochrome P-450 CYP2C19
  • Clarithromycin
  • Omeprazole