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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