A New Modified Concomitant Therapy for Helicobacter pylori Eradication in Turkey

Toros, Ahmet Burak; İnce, Ali Tüzün; Beşir, Kesici; Sağlam, Mustafa; Polat, Zülfıkar; Uygun, Ahmet

doi:10.1111/j.1523-5378.2011.00823.x

Cited by 30 publications

(19 citation statements)

References 15 publications

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“…However, several RCTs compared, in the same study and with the same protocol, two different durations of concomitant therapy, and demonstrated that the longer duration is more effective 215 218–220. Moreover, suboptimal results have been observed with a 5-day treatment duration in Latin America209 (73.5%) and South Korea (58.6%),221 but also in two studies of 14-day treatment from Turkey (75%)222 and South Korea (80.8%) 223. These inferior results have been attributed to the high prevalence of H. pylori strains resistant to clarithromycin and especially metronidazole in these populations 168 170.…”

Section: Working Group 3: Treatmentmentioning

confidence: 99%

Management ofHelicobacter pyloriinfection—the Maastricht V/Florence Consensus Report

Malfertheiner

Mégraud

O’Moráin

et al. 2016

Gut

2,505

3,052

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Section: Working Group 3: Treatmentmentioning

confidence: 99%

Management ofHelicobacter pyloriinfection—the Maastricht V/Florence Consensus Report

Malfertheiner

Mégraud

O’Moráin

et al. 2016

Gut

2,505

3,052

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“…A second outlier study was performed by Toros et al60 in Turkey, where only a 75% eradication rate was achieved despite the fact that high doses of metronidazole (500 mg three times daily) were used and a 14-day regimen was prescribed. It should be taken into consideration that, in Turkey, results with the standard triple therapy have also been far lower than expected.…”

Section: Efficacy Of the Concomitant Regimen For Eradication Of H Pymentioning

confidence: 99%

Update on non-bismuth quadruple (concomitant) therapy for eradication of Helicobacter pylori

Gisbert¹,

Calvet²

2012

CEG

123

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BackgroundTraditional standard triple therapy for Helicobacter pylori (H. pylori) infection (proton pump inhibitor-clarithromycin-amoxicillin) can easily be converted to non-bismuth quadruple (concomitant) therapy by the addition of a nitroimidazole twice daily.AimTo critically review evidence on the role of non-bismuth quadruple therapy (proton pump inhibitor-clarithromycin-amoxicillin-nitroimidazole) in the treatment of H. pylori infection.MethodsBibliographical searches were performed in MEDLINE and relevant congresses up to December 2011. We performed a meta-analysis of the studies evaluating the concomitant therapy, and of the randomized controlled trials comparing the concomitant and the standard triple therapy.ResultsA meta-analysis of 19 studies (2070 patients) revealed a mean H. pylori cure rate (intention-to-treat) of 88% (95% confidence interval from 85% to 91%) for non-bismuth quadruple therapy. We performed a meta-analysis of the randomized controlled studies comparing the concomitant (481 patients) and the standard triple therapy (503 patients). The former was more effective than the latter: 90% versus 78% (intention-to-treat analysis). Results were homogeneous (I2 = 0%). The odds ratio for this comparison was 2.36 (95% confidence interval from 1.67 to 3.34). A tendency toward better results with longer treatments (7–10 days versus 3–5 days) has been observed, so it seems reasonable to recommend the length of treatment achieving the highest cure rates (10 days). Clarithromycin resistance may reduce the efficacy of non-bismuth quadruple therapy, although the decrease in eradication rates seems to be far lower than in standard triple therapy. Experience with the non-bismuth quadruple therapy in patients with metronidazole-resistant strains is still very limited.ConclusionNon-bismuth quadruple (concomitant) therapy appears to be an effective, safe, and well-tolerated alternative to triple therapy and is less complex than sequential therapy. Therefore, this regimen appears well suited for use in settings where the efficacy of triple therapy is unacceptably low.

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“…The poor performance of the quadruple, concomitant regimen here raises questions about whether this strategy can be a worthwhile one in an area of high clarithromycin resistance. In a further study, a levofloxacin-and rifaximin-based quadruple therapy was tested but found only to be equivalent to standard triple therapy in a Korean cohort [29].…”

Section: Nonbismuth-based Quadruple (Concomitant) Therapymentioning

confidence: 99%

Treatment of Helicobacter pylori infection 2012

et al. 2012

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Helicobacter pylori resistance rates to antibiotics vary in different countries and even in different regions of the same country. Choice of treatment is strongly dependent on antibiotic resistance rates. In some countries, triple therapy with a proton-pump inhibitor, amoxicillin, and clarithromycin is still the best option, but eradication results fall short of what would be desired (90-95%) in countries with clarithromycin resistance >20%, bismuth-containing quadruple therapy, or nonbismuth sequential or concomitant therapies may then be the preferred option. Newer antibiotic regimens are awaited. Vaccination would be the best option, especially for developing countries, but little progress has been made in designing a vaccine.A considerable amount of work has been conducted over the last year assessing many issues around Helicobacter pylori eradication therapy. These focussed primarily on assessing the efficacy of current standard triple therapy and exploring new first-line treatments. There was also progress in investigating antibiotic resistance rates, and the rescue therapies required to deal with ensuing treatment failures. There has also been an evolution in the use of adjunctive therapies. This article will address the published literature over the last year pertaining to these topics. Triple TherapyNumerous studies over the last year have assessed the efficacy of standard triple therapy with amoxicillin, clarithromycin, and a proton-pump inhibitor for the eradication of H. pylori, which have been perceived to be in decline in recent years. One such study looked at cure rates reported in all published literature from Spain between 1997 and 2008 and found that while cure rates have in fact been stable over that period, they remain inadequate with a mean cure rate of 80% by intention-to-treat and 83% by per-protocol [1]. Similar results were obtained from a multicenter study in Japan that revealed an eradication rate of 80.7% with an incidence of adverse drug reactions of 4.4% [2]. Other studies have looked at whether the efficacy of triple therapy can be improved by prolonging the course of therapy. In China, a study of shorter regimens showed eradication rates of 76, 89, and 91% for 3-day, 5-day, and 7-day regimens, respectively [3]. Increasing efficacy by prolongation of therapy was also noted in Greek patients, with eradication rates of 74.5% for 7 days, 80.6% for 10 days, and 90.2% for 14 days of therapy [4]. Another study showed that efficacy could be maintained when lower doses of medications were given, which reduced costs and side effects with cure rates of 77.2% for 10 mg rabeprazole, 500 mg amoxicillin, and 250 mg clarithromycin vs 78.9% for the standard 20 mg, 1 g, and 500 mg doses of these drugs [5].Regardless of the type of therapy used, study from Canada showed widespread failure to comply with test and treat in up to 10% of cases and a failure to confirm eradication in 32% [6]. This illustrates that efficacious first-line therapy will always depend on adherence to guidelines by phy...

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A New Modified Concomitant Therapy for Helicobacter pylori Eradication in Turkey

Cited by 30 publications

References 15 publications

Management ofHelicobacter pyloriinfection—the Maastricht V/Florence Consensus Report

Management ofHelicobacter pyloriinfection—the Maastricht V/Florence Consensus Report

Update on non-bismuth quadruple (concomitant) therapy for eradication of Helicobacter pylori

Treatment of Helicobacter pylori infection 2012

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