The high-dose amoxicillin-proton pump inhibitor dual therapy in eradication of Helicobacter pylori infection

ABSTRACT

Introduction

More attention has been paid to the eradication therapy of Helicobactor pylori with the enhancement of health awareness of patients. However, the increasing antibiotic resistance of H. pylori, due to the wide use and abuse of antibiotics, has become a critical factor affecting the efficacy of eradication. To effectively improve the eradication rate of H. pylori, high-dose amoxicillin-proton pump inhibitor (PPI) dual therapy has recently become one of the hot issues.

Areas covered

The authors review the schemes and efficacy of high-dose amoxicillin-PPI dual therapies in eradication of H. pylori infection. The review indicates that the H. pylori eradication rate of the dual therapy is overall comparable to or better than that of bismuth-containing quadruple therapy or standard triple therapy. It is more effective to administer both amoxicillin and PPI 3–4 times daily for 14 days in the high-dose amoxicillin-PPI dual therapy, and esomeprazole seems to be superior to other PPIs.

Expert opinion

The high-dose amoxicillin-PPI dual therapy is currently a promising H. pylori eradication regimen in clinical practice, deserving further verification and discussion. Much more attention should be paid to the influence of CYP2C19 polymorphisms and virulence genotyping on H. pylori eradication, and the homogeneity and objectivity of the comparison among different studies.

KEYWORDS:

• Helicobacter pylori
• eradication therapy
• high-dose dual therapy
• amoxicillin
• proton pump inhibitor

Article highlights

• There is no eternal recommended scheme to eradicate H. pylori, and the composition, dosage and course of the regimens have undergone many changes. There are generally not many regimens achieving the grade A or B success (95–100% or 90–94%).

• With the influences of the factors such as antibiotic resistance, symptom relief, adverse reactions, compliance and eradication rate, it has become an important research direction to increase the dose and frequency of drugs, rather than to increase the kinds of drugs, in the H. pylori eradication schemes over the past two decades.

• The H. pylori eradication rate of the high-dose amoxicillin-PPI dual therapy is overall comparable to or better than that of bismuth-containing quadruple therapy or standard triple therapy. And the incidence of toxic and side effects of the dual therapy was significantly reduced in some reports.

• There were no significant differences in treatment adherence between the high-dose amoxicillin-PPI dual therapy groups and the control groups administered bismuth-containing quadruple therapies or standard triple therapies.

• It is more effective to administer both amoxicillin and PPI 3–4 times daily for 14 days in the high-dose amoxicillin-PPI dual therapy. Esomeprazole seems to be superior to other PPIs.

• Much more attention should be paid to the influence of CYP2C19 polymorphisms and virulence genotyping on H. pylori eradication, and the homogeneity and objectivity of the comparison among different studies.

• The high-dose amoxicillin-PPI dual therapy is currently a promising H. pylori eradication regimen in clinicalpractice. Large sample and multicenter clinical studies are needed.

• Further comparative studies are needed to carry out which regimens of the high-dose amoxicillin-PPI dual therapy are more optimized.

• Further research is needed to compare the high-dose amoxicillin-PPI dual therapy with or without other antibiotics (such as clarithromycin or metronidazole) and the high-dose amoxicillin-based quadruple or triple therapy.

Declaration of interest

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This manuscript has been funded by the Natural Science Foundation of Gansu Province, China (Grant No. 18JR3RA 332 and 18JR3RA326).