Molecular Detection of Antibiotic Resistance and H Pylori Eradication (HELICOSTIC)

The recruitment status of this study is unknown because the information has not been verified recently.
Verified May 2011 by Assistance Publique - Hôpitaux de Paris.
Recruitment status was  Recruiting
Sponsor:
Information provided by (Responsible Party):
Assistance Publique - Hôpitaux de Paris
ClinicalTrials.gov Identifier:
NCT01168063
First received: July 21, 2010
Last updated: December 27, 2011
Last verified: May 2011

July 21, 2010
December 27, 2011
February 2010
August 2011   (final data collection date for primary outcome measure)
H. pylori eradication rate (at 3months according to the two strategies: empirical treatment versus treatment guided by molecular detection of antibiotic resistance) [ Time Frame: at 3 months ] [ Designated as safety issue: No ]
at 3 months according to the two strategies: empirical treatment versus treatment guided by molecular detection of antibiotic resistance
Same as current
Complete list of historical versions of study NCT01168063 on ClinicalTrials.gov Archive Site
Comparative cost of the two strategies [ Time Frame: at 6 months according to the two strategies ] [ Designated as safety issue: No ]
Same as current
Not Provided
Not Provided
 
Molecular Detection of Antibiotic Resistance and H Pylori Eradication
Medico-economic Evaluation of a Therapeutic Strategy Based on Molecular Detection of Antibiotic Resistance in the Management of H Pylori Infection

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.

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.

Interventional
Not Provided
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Treatment
Helicobacter Pylori Infection
  • Drug: Molecular detection of antibiotic resistance
    Helico DR®, triple therapy (Proton Pomp Inhibitor (PPI), amoxicillin, clarithromycin, metronidazole)
    Other Names:
    • Helicobacter Molecular detection of resistance to clarithromycin and quinolones
    • Use of triple therapy base on antibiotics resistances (PPI,amoxicillin,clarithromycin, metronidazole)
  • 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

    Other Name: Standard triple therapy (PPI, amoxicillin, clarithromycin, metronidazole ….)
  • Experimental: Helicobacter pilory triple treatment
    Triple treatment on this arm is based on results of molecular detection of resistance to antibiotics
    Intervention: Drug: Molecular detection of antibiotic resistance
  • Active Comparator: Helicobacter pilori standard recommended treatment
    H.Pylori Eradication rate with empirical treatment
    Intervention: Drug: standard triple therapy (PPI, amoxicillin, clarithromycin, metronidazole)
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.

*   Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
 
Recruiting
500
February 2012
August 2011   (final data collection date for primary outcome measure)

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
Both
18 Years and older
No
Contact: Jean-Charles DELCHIER, PU-PH +33(0)1 49 81 23 71 ext +33 jean-charles.delchier@hmn.aphp.fr
Contact: Nogaye Gaye +33(0)1 49 81 37 52 ext +33 nogaye.gaye@hmn.aphp.fr
France
 
NCT01168063
P090210
Yes
Assistance Publique - Hôpitaux de Paris
Assistance Publique - Hôpitaux de Paris
Not Provided
Principal Investigator: Jean-Charles Delchier, PU-PH Assistance Publique - Hôpitaux de Paris
Assistance Publique - Hôpitaux de Paris
May 2011

ICMJE     Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP