Efficacy of serology driven “test and treat strategy” for eradication of H. pylori in patients with rheumatic disease in the Netherlands

• Published in: European journal of clinical microbiology & infectious diseases Vol. 30; no. 7; pp. 903 - 908
• Main Authors: de Leest, H. T. J. I., Steen, K. S. S., Lems, W. F., van de Laar, M. A. F. J., Huisman, A. M., Kadir, S. W., Houben, H. H. M. L., Kostense, P. J., Kuipers, E. J., Dijkmans, B. A. C., Debets-Ossenkopp, Y. J.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer-Verlag 01.07.2011; Springer; Springer Nature B.V
• Subjects: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents - administration & dosage; Antibiotic resistance; Antibiotics; Antibodies; Antibodies, Bacterial - blood; Biological and medical sciences; Biomedical and Life Sciences; Biomedicine; Biopsy; Diseases of the osteoarticular system; Drug resistance; Endoscopy; Endoscopy, Gastrointestinal; Female; Gastroenterology; Helicobacter Infections - diagnosis; Helicobacter Infections - drug therapy; Helicobacter pylori; Helicobacter pylori - isolation & purification; Histocytochemistry; Histology; Humans; Immunoglobulin G - blood; Infections; Infectious diseases; Internal Medicine; Male; Medical ethics; Medical Microbiology; Medical sciences; Middle Aged; Miscellaneous. Osteoarticular involvement in other diseases; Netherlands; Placebos - administration & dosage; Proton Pump Inhibitors - administration & dosage; Protons; Rheumatic diseases; Rheumatic Diseases - complications; Rheumatology; Serology; Serology - methods; Treatment Outcome; Netherlands; Europe; Clarithromycin; Metronidazole; Misoprostol; Pylorus Infection; Amoxicillin; Human; Infection; Treatment; Microbiology; Diseases of the osteoarticular system; Rheumatism; Serology; Eradication
• ISSN: 0934-9723; 1435-4373
• DOI: 10.1007/s10096-011-1174-5

The treatment of choice of H. pylori infections is a 7-day triple-therapy with a proton pump inhibitor (PPI) plus amoxicillin and either clarithromycin or metronidazole, depending on local antibiotic resistance rates. The data on efficacy of eradication therapy in a group of rheumatology patients on long-term NSAID therapy are reported here. This study was part of a nationwide, multicenter RCT that took place in 2000–2002 in the Netherlands. Patients who tested positive for H. pylori IgG antibodies were included and randomly assigned to either eradication PPI-triple therapy or placebo. After completion, follow-up at 3 months was done by endoscopy and biopsies were sent for culture and histology. In the eradication group 13% (20/152, 95% CI 9–20%) and in the placebo group 79% (123/155, 95% CI 72–85%) of the patients were H. pylori positive by histology or culture. H. pylori was successfully eradicated in 91% of the patients who were fully compliant to therapy, compared to 50% of those who were not (difference of 41%; 95% CI 18–63%). Resistance percentages found in isolates of the placebo group were: 4% to clarithromycin, 19% to metronidazole, 1% to amoxicillin and 2% to tetracycline.