Molecular Detection of Antibiotic Resistance and H Pylori Eradication

NCT ID: NCT01168063

Last Updated: 2013-11-08

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

1386 participants

Study Classification

INTERVENTIONAL

Study Start Date

2010-02-28

Study Completion Date

2013-03-31

Brief Summary

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H pylori eradication failure with recommended triple therapy is mainly related to antibiotic resistance. However,IN VITRO culture of H pylori is uneasy and is not performed in routine practice. A molecular test of antibiotic resistance easy to perform is now available. The aim of the study was to compare eradication rates obtained with the standard treatment and with a treatment guided by the results of the molecular detection of antibiotic resistance.

Detailed Description

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At the present time, H pylori infection is treated with a standard triple therapy. Treatment of naïve patients with triple therapy ( PPI+amoxicillin+clarithromycin for 7 days) markedly decreased last years to reach 70% due to a clarithromycin resistance rate about 20% in France. In case of failure, the recommended second line treatment (PPI+amoxicillin+metronidazole for 14 days) gives a success rate of 60%. However, as culture is uneasy and is only possible in specialised labs sensitivity to antibiotics is not currently studied before treatment.

The aim of the study was to evaluate clinical and medico-economic benefit of the molecular detection of antibiotic resistance in order to guide the treatment.

The test is performed after DNA extraction from biopsy specimens taken at gastroscopy allowing rapid detection of H pylori and clarithromycin or quinolone resistance.

Patients with bacteriologically proven H pylori infection will be randomly allocated to either empirical usual treatment with PPI , amoxicillin 1g, clarithromycin 500 mg X 2 /day for 7 days in naïve patients and PPI, amoxicillin 1g,metronidazole 500 mg X 2 /day for 14 days in patients who failed a first line treatment , or to treatment guided by the molecular test: PPI , amoxicillin 1g, clarithromycin 500 mg X 2 /day for 7 days in case of sensitivity to clarithromycin.In case of resistance to clarithromycin, quinolone should be given and in case of resistance to quinolone clarithromycin should be given. In case of resistance to both antibiotics metronidazole should be given.

Eradication will be assessed by performing 4 weeks after the completion of treatment with Urea Breath Test.

Conditions

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Helicobacter Pylori Infection

Keywords

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Helicobacter pylori Diagnostic molecular testing Antibiotic resistance Treatment protocols

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Helicobacter pilory triple treatment

Triple treatment on this arm is based on results of molecular detection of resistance to antibiotics

Group Type EXPERIMENTAL

Molecular detection of antibiotic resistance

Intervention Type DRUG

Helico DR®, triple therapy (Proton Pomp Inhibitor (PPI), amoxicillin, clarithromycin, metronidazole)

Helicobacter pilori standard recommended treatment

H.Pylori Eradication rate with empirical treatment

Group Type ACTIVE_COMPARATOR

standard triple therapy (PPI, amoxicillin, clarithromycin, metronidazole)

Intervention Type DRUG

2 lines of treatments :

1\) PPI + Amoxicillin + Clarithromycin for 7 days

1\) PPI + Amoxicillin + Metronidazole for 14 days

Interventions

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Molecular detection of antibiotic resistance

Helico DR®, triple therapy (Proton Pomp Inhibitor (PPI), amoxicillin, clarithromycin, metronidazole)

Intervention Type DRUG

standard triple therapy (PPI, amoxicillin, clarithromycin, metronidazole)

2 lines of treatments :

1\) PPI + Amoxicillin + Clarithromycin for 7 days

1\) PPI + Amoxicillin + Metronidazole for 14 days

Intervention Type DRUG

Other Intervention Names

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Helicobacter Molecular detection of resistance to clarithromycin and quinolones Use of triple therapy base on antibiotics resistances (PPI,amoxicillin,clarithromycin, metronidazole) Standard triple therapy (PPI, amoxicillin, clarithromycin, metronidazole ….)

Eligibility Criteria

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Inclusion Criteria

* H pylori infection bacteriologically confirmed
* Age \> 18 years
* Naïve patient or one failure of the first line recommended treatment
* Patient referred to one out of the centres participating in the study

Exclusion Criteria

* H pylori positive patient with at least failure of two lies of treatment
* patients with previous adverse event with PPI, amoxicillin, clarithromycin, levofloxacin or metronidazole
* PPI or antibiotic treatment in progressor stopped for less than 4 weeks
* patient with other severe sickness
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Assistance Publique - Hôpitaux de Paris

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Jean-Charles Delchier, PU-PH

Role: PRINCIPAL_INVESTIGATOR

Assistance Publique - Hôpitaux de Paris

Locations

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Henri Mondor Hospital

Créteil, , France

Site Status

Countries

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France

References

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Breuer T, Graham DY. Costs of diagnosis and treatment of Helicobacter pylori infection: when does choosing the treatment regimen based on susceptibility testing become cost effective? Am J Gastroenterol. 1999 Mar;94(3):725-9. doi: 10.1111/j.1572-0241.1999.00943.x.

Reference Type RESULT
PMID: 10086658 (View on PubMed)

Delchier JC, Bastuji-Garin S, Raymond J, Megraud F, Amiot A, Cambau E, Burucoa C; HELICOSTIC Study Group. Efficacy of a tailored PCR-guided triple therapy in the treatment of Helicobacter pylori infection. Med Mal Infect. 2020 Sep;50(6):492-499. doi: 10.1016/j.medmal.2019.06.001. Epub 2019 Jun 27.

Reference Type DERIVED
PMID: 31257067 (View on PubMed)

Other Identifiers

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P090210

Identifier Type: -

Identifier Source: org_study_id