Microsoft word - stuppy - ntz to tx hp acg 2010 submitted.doc
Presented at the American College of Gastroenterology 2009 Annual Scientific Meeting and Postgraduate Course. October 23-28, 2009; San Diego, CA.
Nitazoxanide and Sucralfate for the Treatment of Helicobacter pylori Infection
Purpose: In the United States the incidence of Helicobater pylori (HP) infection has been estimated to be as high as 40% of the general population. While most infections may be deemed sub-clinical, HP is classified as a type 1 carcinogen by the WHO and is the primary cause for gastric cancer, peptic ulcers, and gastritis. Most treatment regimens incorporate 3 or 4 drugs with at least two antibiotics and an anti-secretory agent. However, these regimens can be cumbersome and difficult to tolerate. Furthermore, in clinical practice few routinely achieve eradication rates exceeding 90%. Nitazoxanide is a thiazolide antibiotic that has previously been shown to be effective in a variety of HP combination regimens (Anitmicrob Agent Chemother 1998;42:2836-40; AJG 2008;103(S1):S44&S52) . Sucralfate is a cytoprotective agent that has demonstrated activity against HP and has been reported to enhance the effects of other antibiotics (Aliment Pharmacol Ther 2000;14:919-22). The purpose of this paper is to report the efficacy of a simple, novel HP regimen utilizing nitazoxanide and sucralfate. Methods: Patients with a positive salivary antibody test for HP (Diagnos-Techs, Inc., Kent, WA) were eligible for treatment. Eligible patients were apprised of various treatment options and consented to the regimen. All patients were treated with nitazoxanide 1 g twice daily and sucralfate 1 g twice daily for 14 days. The use of gastric acid suppressants was not al owed. Follow-up testing for the continued presence of salivary HP antibodies was made one to six months after the end of therapy. Previous studies have compared the utility of salivary testing versus stool antigen and the urea breath tests. Results: The study enrol ed 26 patients, mean age 39 years, 13/13 males/females and a mean fol ow-up of 96 days. Overal HP eradication was found in 73% (19/26) patients. The regimen was well-tolerated with most patients reporting yel owing of the urine, and a few complaining of gastrointestinal discomfort during therapy which had resolved at fol ow-up. Conclusions: In this evaluation, the combination of nitazoxanide with sucralfate appeared to be a moderately effective regimen for the treatment of HP. The cure rates achieved with this regimen were slightly less than those in a previous study combining nitazoxanide with a proton-pump inhibitor only to treat HP (Anitmicrob Agent Chemother 1998;42:2836-40). As seen in other HP studies with nitazoxanide, the addition of another antibiotic to the regimen would likely increase the effectiveness of the regimen. Further studies are needed to verify this hypothesis.
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