Comparison between the two drug regimens of "Amoxicillin-Rifaximin-PPI" and "Amoxicillin-Clarithromycin-PPI" for the treatment of H.pylory infection

Abstract

Helicobacter pylori is considered one of the most significant gastrointestinal infections, affecting over 40% of the global population. This bacterium plays a crucial role in the development of gastrointestinal diseases, including gastritis and peptic ulcers, and is classified by the World Health Organization as a Group 1 carcinogen. The increasing resistance of Helicobacter pylori to common antibiotics such as clarithromycin and metronidazole has posed challenges to existing treatments and underscores the need for new therapeutic approaches, such as the use of rifaximin. Objective: This study aimed to compare the efficacy of two four-drug regimens based on rifaximin (including rifaximin, amoxicillin, pantoprazole, and bismuth) and clarithromycin (including clarithromycin, amoxicillin, pantoprazole, and bismuth) in eradicating Helicobacter pylori infection. Methods and Materials: In this double-blind clinical trial, 85 patients with Helicobacter pylori infection were randomly assigned to two treatment groups. The first group received the rifaximin-based four-drug regimen, while the second group received the clarithromycin-based regimen. After 14 days of treatment, the therapeutic success was assessed using a stool antigen test and clinical symptom evaluation. Results: The results showed that the eradication rate of Helicobacter pylori in the clarithromycin group was 74.4%, while in the rifaximin group it was 71.4%. No statistically significant difference was observed between the two groups (P=0.59), but the rifaximin group had fewer side effects and higher drug acceptance. Additionally, rifaximin had a more significant effect in reducing bloating symptoms (P=0.046).