Azithromycin Effective Alternative to Clarithromycin in H. pylori Therapy, suggests research
Researchers have found that azithromycin is a good substitute for clarithromycin in the combination therapies of triple and quadruple therapy for the eradication of Helicobacter pylori. This conclusion is reached through the study of a retrospective report carried out at King Hussein Medical Centre, Amman, Jordan. The study was published in the Cureus by Sami H. and colleagues.
This was an observational, single-center study involving 1,076 patients treated for H. pylori infection at King Hussein Medical Centre from January 2023 to May 2024. Patients were stratified into six eradication regimens (I-VI) based on the macrolides used: clarithromycin or azithromycin, PPI doses, and treatment duration, which were either 7 days or 10-14 days. Clarithromycin was used in Regimens I-III, and azithromycin was used in Regimens IV-VI.
Proton Pump Inhibitor (PPI) Doses:
• Low-intensity dose: 20-40 mg/d (omeprazole).
• High-intensity dose: 80 mg/d.
Patients were submitted to a stool antigen test, six weeks after treatment, for verification of eradication. PPIs were withdrawn two weeks before the test to avoid biases. Treatment adherence and the statistical association of treatment success with variables such as macrolide type, length of regimen, and degree of adherence were assessed with chi-square tests and through multiple logistic regression models.
Patient Characteristics:
• Number of patients: 1,076.
• Gender: 49.3% female (530 patients), 50.7% male (546 patients).
• Age: 78.2% (841) less than 60 years; 21.8% (235) 60 or older.
Eradication Success:
• Significantly higher eradication rates for azithromycin-based treatments than for clarithromycin-based treatments.
• Odds ratio of azithromycin treatment effect on success: 1.780 (95% CI: 1.378-2.299).
Treatment Adherence:
• Patient adherence had a significant effect on treatment success. Compliance plays a significant role in H. pylori eradication therapy.
• Most of the treatments lasted 7-14 days, but there were no significant differences in terms of effectiveness when adherence was kept.
Azithromycin would be a reasonable and effective alternative to clarithromycin for H. pylori infection, especially in triple and quadruple eradication regimens. Optimizing macrolide selection, treatment duration, and adherence strategies will improve the rate of eradication and better outcomes for patients, especially those residing in areas with limited antibiotic choices.
Reference:
Alhijazien SH, Daoud S, Alzayadi MT, Al Sarhan MR, Aldomi MK, Al Shawabkeh TA, Alsmadi MM. Comparative Efficacy of Azithromycin and Clarithromycin in the Management of Helicobacter pylori Infection. Cureus. 2024 Oct 21;16(10):e72033. doi: 10.7759/cureus.72033. PMID: 39569309; PMCID: PMC11578150.
