Correspondence

Helicobacter pylori

N Engl J Med 2003; 348:363-365January 23, 2003

Article

To the Editor:

The review article by Suerbaum and Michetti on Helicobacter pylori infection (Oct. 10 issue)1 lists dual therapy with ranitidine bismuth citrate and clarithromycin as a treatment option approved by the Food and Drug Administration. Ranitidine bismuth citrate tablets for use in combination with clarithromycin to eradicate H. pylori infection in patients with an active duodenal ulcer were approved on August 8, 1996. However, in 1999, Glaxo Wellcome voluntarily withdrew the product from the U.S. market.

Dual-therapy regimens containing clarithromycin as the sole antimicrobial agent are less effective than approved triple-therapy regimens containing two antimicrobial agents, and the treatment guidelines issued by the American College of Gastroenterology no longer include dual-therapy regimens.2 Moreover, dual-therapy regimens containing clarithromycin as the sole antimicrobial agent may limit future treatment options by inducing resistance. Rates of treatment failure and rates of emerging resistance to clarithromycin with dual- and triple-therapy regimens are shown in Table 1Table 1Rates of Treatment Failure and Emerging Resistance to Clarithromycin with Dual- and Triple-Therapy Regimens for Helicobacter pylori Infection..3,4 In summary, the potential for higher rates of emerging resistance to clarithromycin with dual-therapy regimens, as compared with triple-therapy regimens, should be taken into account when a treatment regimen is selected.

Joette M. Meyer, Pharm.D.
Food and Drug Administration, Rockville, MD 20850

Robert J. Hopkins, M.D., M.P.H.&T.M.
Dynport Vaccine, Frederick, MD 21702

4 References

1. 1

   Suerbaum S, Michetti P. Helicobacter pylori infection. N Engl J Med 2002;347:1175-1186
   Full Text | Web of Science | Medline

2. 2

   Howden CW, Hunt RH. Guidelines for the management of Helicobacter pylori infection. Am J Gastroenterol 1998;93:2330-2338
   CrossRef | Web of Science | Medline

3. 3

   Clarithromycin (Biaxin). North Chicago, Ill.: Abbott Laboratories, June 2002 (package insert).
   

4. 4

   Esomeprazole magnesium (Nexium). Wilmington, Del.: AstraZeneca, 2001 (package insert).
   

To the Editor:

The role of testing after treatment to eradicate H. pylori is growing in importance in clinical practice.1-3 In their review of H. pylori infection, Suerbaum and Michetti state that stool antigen tests are suitable for follow-up of infection, provided that an eight-week interval is allowed after therapy. However, a prospective, multicenter study4 showed that a positive result on the stool antigen test, performed just seven days after completion of therapy, identified patients in whom eradication of H. pylori infection had been unsuccessful. Such a test, with this timing, should be considered as a useful tool in assessing the outcome of treatment of H. pylori infection.

Luca Mascitelli, M.D.
Casa di Cura Città di Udine, 33100 Udine, Italy
lumasci@libero.it

Francesca Pezzetta, M.D.
Ospedale San Michele, 33013 Gemona del Friuli, Italy

4 References

1. 1

   Rokkas T, Karameris A, Mavrogeorgis A, Rallis E, Giannikos N. Eradication of Helicobacter pylori reduces the possibility of rebleeding in peptic ulcer disease. Gastrointest Endosc 1995;41:1-4
   CrossRef | Web of Science | Medline

2. 2

   Vakil N, Hahn B, McSorley D. Clarithromycin-resistant Helicobacter pylori in patients with duodenal ulcer in the United States. Am J Gastroenterol 1998;93:1432-1435
   CrossRef | Web of Science | Medline

3. 3

   Malfertheiner P, Megraud F, O'Morain C, et al. Current concepts in the management of the Helicobacter pylori infection -- the Maastricht 2-2000 Consensus Report. Aliment Pharmacol Ther 2002;16:167-180
   CrossRef | Web of Science | Medline

4. 4

   Vaira D, Vakil N, Menegatti M, et al. The stool antigen test for detection of Helicobacter pylori after eradication therapy. Ann Intern Med 2002;136:280-287
   Web of Science | Medline