Comparison between the azithromycin and clarithromycin in one week triple therapy of helicobacter pylori

الملخص EN

Background : The role of Helicobacter pylori (H.pylori) in upper GI disease has been studied and its treatement in special groups of patients is necessary.

Clarithromycin has been recognized as a major ingredient of the standard short term therapy for H.pylori.

To compare the effect of azithromycin which is a new macrolide with clarithromycin, a prospective open study was conducted to evaluate the therapeutic effect of azithromycin against clarithromycin in the triple therapy. Method : Patients attending at GI clinic of our hospital with the complain of epigastric pain were included in this study and after endoscopy and confirmation of H.pylori by rapid urease test irrespective to the presence or absence of duodenal ulcer (DU), they were included in a single center open study.

Patients were divided into two groups of LAC (lansoprazole 30mg b.i.d, amoxicillin 1000mg b.i.d.

and clarithromycin 500mg b.i.d) and LAA (lansoprazole 30mg b.i.d, amoxicillin 1000mg b.i.d, and azithromycin 250mg b.i.d) who were both treated for one week.

The efficacy is determined at least after four weeks of completing the anlibiotics by C13-urea breath test (C13UBT). Results : A total of 110 patients were included in both of LAC and LAA groups, LAC group consisted of 64 patients of whom 20 patients had DU and 44 cases had normal endoscopic finding, while in the group of LAA there were a total of 46 patients of whom 14 had DU and 44 had normal endoscopic finding. After the completion of treatment, to patients suffering from DU ranitidine 100mg B.i.d was given for another 3 weeks.

Out of 64 patients from the group of LAC 59 patients (92 %) cleared the organism (95 % CI = 8-92) while out of 46 patients from group LAA 26 patients (56.5 %) cleared the organism (95 % CI = 41-71) and using the chi-squared method there was a significant difference in the level of its efficacy in the treatment regimen against H-pylori (P < 0.00001).

besides in the comparison of subgroups of those with DU, out of 20 patients of group LAC, 19 patients (95 %) had cleared (95 % CI = 75-99) which means that in this two subgroups there was also a significant difference (P < 0.003).

Side effects of medicines used in the group of LAA were lesser than that of LAC. Conclusion : Although in some studies substitution of azithromycin for clarithromycin is recommended, but our study shows that in a low dose of 250 mg b.i.d, azithromycin has not had a considerable effect on the H.pylori and further studies are recommended.