Copyright
©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
Efficacy and safety of low-dose tetracycline, amoxicillin quadruple therapy in Helicobacter pylori infection: A retrospective single center study
Yi-Ru Zhao, Xin-Jie Wang, Meng-Jia Zhu, Ang-Li Chen, Dian Zhang, Qin Du, John J Kim, Wei-Ling Hu
Yi-Ru Zhao, Xin-Jie Wang, Meng-Jia Zhu, Ang-Li Chen, Dian Zhang, Wei-Ling Hu, Department of Gastroenterology, Sir Run Run Shaw Hospital, Medical School, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
Yi-Ru Zhao, Department of Gastroenterology, The First Affiliated Hospital, Medical School, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
Qin Du, Department of Gastroenterology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang Province, China
John J Kim, Keck School of Medicine, University of Southern California, Los Angeles, CA 90089-9021, United States
Wei-Ling Hu, Institute of Gastroenterology, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
Author contributions: Zhao YR, Zhu MJ, and Hu WL designed the research study; Zhao YR and Wang XJ collected and analyzed the data; Zhao YR wrote the manuscript; Chen AL, Zhang D, and Kim JJ reviewed and edited the manuscript; Zhao YR, Du Q, and Kim JJ revised the manuscript; Hu WL supervised this work. All authors have read and approved the final manuscript.
Institutional review board statement: This study was reviewed and approved by the Institutional Review Board of Sir Run Run Shaw Hospital, Medical School, Zhejiang University, Hangzhou (Approval No. SRRSH: 2024-0053).
Informed consent statement: Patient consent was waived due the impossibility of identifying patients and the retrospective design of the investigation.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The datasets generated and/or analyzed during the current study are not publicly available but are available from the corresponding author upon reasonable request.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Wei-Ling Hu, MD, Doctor, Department of Gastroenterology, Sir Run Run Shaw Hospital, Medical School, Zhejiang University, No. 3 East Qingchun Road, Hangzhou 310016, Zhejiang Province, China.
huweiling@zju.edu.cn
Received: May 14, 2024
Revised: September 9, 2024
Accepted: September 24, 2024
Published online: October 21, 2024
Processing time: 150 Days and 20 Hours
BACKGROUND
Helicobacter pylori (H. pylori) eradication rates have declined with the rise of antibiotic-resistant strains in recent years. Although highly effective with a low prevalence of resistance, standard dose tetracycline is associated with frequent adverse events. The efficacy and safety of low-dose tetracycline as part of tetracycline and amoxicillin-containing bismuth quadruple therapy are not well described.
AIM
To compare the efficacy and safety of low-dose compared to standard dose tetracycline with combined amoxicillin-containing bismuth quadruple therapy in patients with H. pylori infection.
METHODS
Consecutive patients with H. pylori infection receiving tetracycline, amoxicillin, proton pump inhibitor, and bismuth for 14 days at Sir Run Run Shaw Hospital (1/2022-6/2023) were evaluated. The low-dose tetracycline group received tetracycline 500 mg twice daily (bid) while the standard dose group received 750 mg bid or 500 mg three times daily (tid). Primary endpoints were H. pylori eradication rate and treatment-related adverse events.
RESULTS
The mean age of the 218 patients was 48.7 ± 14.0 years, 120 (55%) were male, and 118 (54.1%) received treatment as primary therapy. Furthermore, 73 (33%) patients received low-dose tetracycline (500 mg bid) and 145 (67%) received standard dose tetracycline including 500 mg tid in 74 (33%) and 750 mg bid in 71 (33%). On intention-to-treat analysis, H. pylori eradication rates were 89% [95% confidence interval (CI): 82%-96%] in the 500 mg bid group, 82% (95%CI: 74%-91%) in the 500 mg tid group, and 79% (95%CI: 69%-89%) in the 750 mg bid group without a statistically significant difference (P = 0.25). The incidence of adverse events was lower in the low-dose compared to the standard dose group (12.3% vs 31.1% or 23.9%; P = 0.02).
CONCLUSION
Low-dose tetracycline combined with amoxicillin quadruple therapy for 14 days achieved a high eradication rate and fewer adverse events compared to the standard dose tetracycline regimen in patients with H. pylori infection.
Core Tip: Helicobacter pylori (H. pylori) eradication rates have declined with the rise of antibiotic-resistant strains in recent years. Although highly effective, the standard dose of tetracycline as part of the H. pylori treatment regimen is associated with a high incidence of adverse events. Our results demonstrated that low-dose tetracycline combined with amoxicillin as part of bismuth-containing quadruple therapy can achieve a high eradication rate and fewer adverse events compared to standard dose tetracycline in patients with H. pylori infection.
