Aim. Evaluation of the efficacy and safety of quadrupletherapy without bismuth (concomitant therapy) in patients with Helicobacter pylori - associated gastric ulcer and duodenal ulcer in the framework of a comparative research in the population of patients in Russia. Materials and methods. A prospective randomized trial was conducted, which included 210 patients with H. pylori - associated gastric/duodenal ulcer without complications. During the process of randomization, the patients were divided into three equal groups (n=70) depending on the prescribed 10-day scheme of eradication therapy (ET): the first group received the classic triple scheme (Omeprazole 20 mg 2 times a day, Amoxicillin 1000 mg 2 times a day and Clarithromycin 500 mg 2 times a day); the second group received quadruple therapy with bismuth drugs (Omeprazole 20 mg 2 times a day, Tetracycline 500 mg 4 times a day, Metronidazole 500 mg 3 times a day, Bismuth subcitrate potassium 120 mg 4 times a day); the third group received quadruple therapy without bismuth - concomitant therapy (Omeprazole 20 mg 2 times a day, Amoxicillin 1000 mg 2 times a day, Clarithromycin 500 mg 2 times a day and Metronidazole 500 mg 2 times a day). Diagnostics of H. pylori infection during screening and control of eradication was carried out via the fast urease biopsy sample test and urea breath test system. Control of the effectiveness of ET of the microorganism was carried out not earlier than 4 weeks after the end of the treatment. During the course of therapy, the frequency of development of side effects was assessed using a special questionnaire. Results and discussion. The effectiveness of triple therapy was 72.8% (ITT; 95% CI of 62.17-83.54) and 78,4% (PP; 95% CI 68.19-88.72); quadruple therapy with the preparation of bismuth - 80.0% (ITT; 95% CI 70.39-89.6) and 84,8% (PP; 95% CI, 75.96-93.73); quadruple therapy without bismuth - concomitant therapy - 84.2% (ITT; 95% CI 75.54-93.02) and 92.1% (PP; 95% CI 85.43-98.94). Quadruple therapy without bismuth was reliably more effective than the classical triple therapy in the PP selection (p=0.044883). Statistical analysis showed a tendency to poorer effectiveness of ET in patients who had previously used antibiotic therapy (OR 0.4317; 95% CI 0.1776-1.049), and in individuals with a rapid metabolism genotype - CYP2C19*1/*1 (OR 0.12; 95% CI 0.005848-2.4624). The frequency of development of side effects during the use of triple therapy was 18.5% (95% CI of 9.23-27.91), when using quadruple therapy with bismuth - 20.0% (95% CI 10.39-29.6), and with the use of quadruple therapy without bismuth - concomitant therapy - 24.2% (95% CI 13.98-34.58). Conclusion. This prospective randomized study demonstrated the high efficiency of quadruple therapy without bismuth (concomitant therapy) in the framework of eradication of H. pylori infection in Russia.

Objectives: Coagulase-negative staphylococci (CNS) are commensal skin microbiota but may also cause septicemia, endocarditis, and systemic infections. Staphylococcus lugdunensis, is a member of CNS, ​​but their antibiotic susceptibility test should be evaluated as Staphylococcus aureus not as CNS. We aimed to investigate S.lugdunensis and selected CNS strains by simple biochemical method and determination of their susceptibilities to antibiotics. Methods: A total of 251 CNS isolates were collected from blood culture bottles sent to Istanbul Faculty of Medicine Department of Medical Microbiology, between 2018 and 2019. PYR (pyrrolidonyl arylamidase) and ODC (ornithine decarboxylase) tests were performed on total of CNS isolates and API Staph was used for identification of the isolates giving positive result in both or either of these two tests. Disk diffusion method was used for the determination of antibiotic susceptibility of the isolates. S. aureus ATCC 25923 and S S.lugdunensis ATCC® 49576 strains were used as quality control strains in disc diffusion method, and biochemical tests, respectively. Results: Twenty three out of 251 CNS isolates were positive in each or both of PYR and ODC tests. We detected the first S.lugdunensis isolate from eye vitreous fluid of patient developed a postoperative endophthalmitis in Turkey. This isolate gave dual positive with ODC, PYR, and API Staph. Other 22 CNS isolates were from blood cultures and distributed as follows; 14 Staphylococcus haemolyticus and three Staphylococcus chromogenes isolates were PYR positive and ODC negative and five Staphylococcus epidermidis isolates were ODC positive and PYR negative. All isolates except S.lugdunensis were resistant to penicillin (95.7%) and 20 (87.0%) isolates were found to be methicillin resistant. Conclusions: ODC and PYR are cost effective tests and easily applicable for accurate identification of S.lugdunensis, and eliminating of opportinistic pathogens such as S. epidermidis, S. haemolyticus, and S. chromogenes from other CNS species in postoperative endophthalmitis and pateints with malignancies. Linezolid was very effective (100%) on four selected CNS species. doi: https://doi.org/10.12669/pjms.38.3.4738 How to cite this:Veliev A, Nakipoglu Y. Investigation of Staphylococcus lugdunensis and Selected Coagulase Negative Staphylococci Isolated from Blood Culture bottles and Determination of their Sensitivities to Antibiotics. Pak J Med Sci. 2022;38(3):---------.  doi: https://doi.org/10.12669/pjms.38.3.4738 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

The article presents the results of pharmacoeconomic analysis of classical and alternative schemes of the first line of Helicobacter pylori eradication therapy used in Russian practice. The most profitable from the economic point of view were sequential therapy, quadrotherapy with bismuth drug and hybrid therapy. In turn, from the point of view of clinical and economic balance, such schemes as triple therapy with addition of bismuth drug, as well as quadrotherapy without bismuth drug were the most optimal.

Д.Н. АНДРЕЕВ, к.м.н., А.М. ВЕЛИЕВ Московский государственный медико-стоматологический университет им. А.И. Евдокимова Минздрава России ЗНАЧЕНИЕ АДЕКВАТНОЙ КИСЛОТОСУПРЕССИИ В РАМКАХ ТЕРАПИИ HELICOBACTER PYLORI-АССОЦИИРОВАННЫХ ЗАБОЛЕВАНИЙ В статье систематизированы литературные данные о роли адекватной кислотосупрессии в рамках терапии Helicobacter pylori-ассоциированных заболеваний. Повышение уровня рН в желудке коррелирует с эффективностью проводимой эрадикационной терапии. Так, при более высоких значениях рН снижаются минимальные ингибирующие концентрации амоксициллина, кларитромицина и метронидазола, увеличивая чувствительность Helicobacter pylori к этим антибактериальным препаратам. Помимо этого, увеличение рН в желудке способствует повышению устойчивости ряда антибактериальных средств, что повышает вероятность успешной эрадикации микроорганизма. Ключевые слова:Helicobacter pylori, ингибиторы протонной помпы, рабепразол, эрадикационная терапия. D.N. ANDREEV, PhD in medicine, A.M. VELIEV Yevdokimov Moscow State University of Medicine and Dentistry of the Ministry of Health of Russia SIGNIFICANCE OF ADEQUATE ACID SUPPRESSION AS PART OF HELICOBACTER PYLORI-ASSOCIATED DISEASE THERAPY The article presents a systematized review of the literature data on the role of adequate acid suppression in the treatment ofHelicobacter pylori-associated diseases. The increased pH levels in the stomach correlate with the efficacy of eradication therapy. Thus, minimal inhibitory concentrations of amoxicillin, clarithromycin and metronidazole decrease at higher pH levels, increasing the Helicobacter pylori sensitivity to these antibacterial drugs. In addition, the increased pH levels in the stomach contribute to the stability of some antibacterial agents, which increases the likelihood of eradication success.