Efficacy of 'Triple Therapy' in Eradicating Ulcer Related Helicobacter pylori Infection at a Tertiary Hospital in Fiji-A Pilot Study.

BACKGROUND

Fiji currently uses a seven-day Clarithromycin based triple therapy regimen for Heliobacter pylori (H. pylori) eradication, and the local eradication rate is unknown. H. pylori testing is performed using a rapid urease test (RUT) during gastroscopy in Fiji.

METHODS

A year-long prospective observational study was undertaken at the Colonial War Memorial Hospital in Fiji. Eligible participants included patients who had peptic ulcer disease (PUD) on gastroscopy and a positive RUT. Consenting participants were prescribed Clarithromycin based triple therapy for 7 days, and underwent a second gastroscopy with RUT after 6 to 8 weeks. Participants who tested positive on a repeat RUT received Clarithromycin based triple therapy for 14 days, and underwent a third gastroscopy and RUT. Participants who remained positive for H. pylori were prescribed quadruple therapy for 14 days.

RESULTS

Forty-nine patients were enrolled in the study. Thirty-six (73.5%) had a negative RUT after a seven-day Clarithromycin-based regimen. Eleven of the 13 participants who remained positive eradicated H. pylori after being given another course of the same regimen for 14 days, resulting in a final eradication rate of 95.9%. The remaining two participants received quadruple therapy for 14 days.

CONCLUSION

This study demonstrates an eradication rate of 73.5% using a seven-day Clarithromycin-based regimen in Fiji among H. pylori positive patients with PUD on gastroscopy. This was significantly improved using a 14-day regimen. H. pylori has reduced susceptibility to the current seven-day Clarithromycin based regimen. Future local guidelines should extend to 14 days to achieve a greater eradication rate.