A systematic comparison of triple therapies for treatment of <i>Helicobacter pylori</i> infection with proton pump inhibitor/ ranitidine bismuth citrate plus clarithromycin and either amoxicillin or a nitroimidazole

Janssen, Marcel J.R.; Oijen, Arnoud H A M van; Verbeek, A.L.M.; Jansen, J. B. M. J.; Boer, W. A. De

doi:10.1046/j.1365-2036.2001.00974.x

Cited by 79 publications

(40 citation statements)

References 69 publications

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“…85 RBC-based, triple regimens containing F were as efficient as the PPI-based therapies: this is in agreement with the meta-analysis which showed that RBC-based standard triple therapies achieved PER of 73-83%, [80][81][82] and in direct comparative trials, the OR for RBC versus PPI-based therapies was 1.15 (CI 0.8-1.64). 86,87 The number of studies and patients included in our study was rather small, and in fact RBC is recommended as first-line therapy only in the 2nd Maastricht consensus, 6 it is not mentioned in the AsianPacific and Latin-American statements 8,9 and its availability in these areas is rather limited.…”

Section: Discussionmentioning

confidence: 99%

Nitrofuran‐based regimens for the eradication of Helicobacter pylori infection

Buzás¹,

Józan

2007

J of Gastro and Hepatol

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Several aspects of Helicobacter pylori eradication have been meta-analyzed; however, nitrofuran-based therapies constitute an exception. The aim of this study was the systematic review and meta-analysis of the effect of furazolidone-and nitrofurantoin-based regimens in the eradication of infection. Studies evaluating the effects of nitrofurans on H. pylori were identified from Medline, EMBASE, the Cochrane Controlled Trials Register and congress abstracts. The studies were classified into groups based on first-, second-and third-line regimens. The pooled eradication rates and combined odd ratios of the individual studies were calculated and compared with the published meta-analysis. The factors influencing the efficiency of the regimens were also analyzed. Side-effects of nitrofuranbased regimens were also analyzed. The pooled eradication rate of primary proton pump inhibitor-based regimens containing furazolidone was 76.3% .2). The odds ratio for furazolidone-based regimens versus standard triple therapies was 2.34 (CI 0.76-3.92). Ranitidine bismuth citrate + furazolidone-based triple regimens were equally efficient (83.5%, CI 74.0-93.0, P = 0.06 versus triple therapies). Schedules including a H2 antagonist + furazolidone + one other antibiotic achieved pooled eradication rates of 79.9% (CI 67.8-89.9, P = 0.04). Bismuth-based triple therapies achieved 84.5% (CI 72.6-93.0, P = 0.002). Primary quadruple regimens containing furazolidone were superior to triple therapies (83.4%, CI 69.7-92.3, P = 0.01). Second-line schedules containing furazolidone obtained eradication rates of 76.1% (CI 66.4-85.0, P = 0.28 versus primary regimens). Third-line 'rescue' therapies were efficient in 65.5% of the cases (CI 56.3-75.5, P = 0.0001). Side-effects of the regimens containing furazolidone were more frequent than in standard therapies (P = 0.02). The combined odds ratio of side-effects for furazolidonebased versus standard therapies was 0.74 (CI 0.32-1.98). The duration of treatment, but not the furazolidone dose, influenced the treatment outcome. Primary triple regimens containing furazolidone are slightly less efficient than the standard primary combinations; primary quadruple regimens were more efficient than triple therapies. Furazolidone is also efficient as a component of second-line or rescue therapies.

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Section: Discussionmentioning

confidence: 99%

Nitrofuran‐based regimens for the eradication of Helicobacter pylori infection

Buzás¹,

Józan

2007

J of Gastro and Hepatol

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“…7 A large variation in efficacy exists between studies in these treatments regimens, with 95% CI ranging from 71 to 96% for ranitidine bismuth citrate triple therapies, and from 24 to 100% for PPI triple therapies. 8 Furthermore, triple and quadruple therapies seem to be also roughly equivalent in terms of effectiveness when administered as first-line treatment. 17 Subsequent second-line therapy should use quadruple therapy with a PPI, bismuth, metronidazole and tetracycline, but a recent review on rescue regimens reported as the weighted eradication mean with this rescue treatment was of 77.2% 18 Therefore, it remains a therapeutic dilemma which treatments using in those 20-30% of patients still infected after two eradication courses.…”

Section: Discussionmentioning

confidence: 99%

“…[2][3][4][5][6][7] However, the efficacy of these treatments is often well below the 90% of eradication rate according to intention-to-treat (ITT) analysis. 8 Treatment failures occur principally because of poor patient compliance or bacterial resistance. 9 As suggested from the Maastricht 2000 Consensus Report, subsequent second-line therapy should use quadruple therapy with a PPI, bismuth, metronidazole and tetracycline or a triple therapy changing one antibiotic (metronidazole instead of amoxicillin, or vice versa).…”

Section: Introductionmentioning

confidence: 99%

A 10‐day levofloxacin‐based triple therapy in patients who have failed two eradication courses

Gatta

Zullo

Perna

et al. 2005

Aliment Pharmacol Ther

109

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Background: A standard third-line treatment is lacking, and European guidelines recommend performing culture in these patients. However, the use of this procedure as 'routine practice' is definitively not feasible. Aim: To evaluate the eradication rate of a 10-day levofloxacin-based triple therapy in patients who have failed two eradication courses for Helicobacter pylori. Methods: A total of 151 patients with persistent Helicobacter pylori infection after two treatments were studied. Patients were considered positive if two of three endoscopic tests were positive. Susceptibility testing was also performed. Patients received a standard dose of

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“…However, in recent years the efficacy of the standard first-line triple therapy has also been decreasing dramatically, mainly due to development of resistance to the drugs (35,59). Failure to cure H. pylori infection has been noted for more than 20 to 30% of patients (37). In addition, several studies have found an eradication rate lower than 75% (6,11,59), and values as low as 25 to 45% have also been recently reported (22,24).…”

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confidence: 99%

In Vitro Antibacterial Activity of Acyl-Lysyl Oligomers againstHelicobacter pylori

Makobongo

Kovachi

Gancz

et al. 2009

Antimicrob Agents Chemother

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The gastric pathogen Helicobacter pylori has developed resistance to virtually all current antibiotics; thus, there is a pressing need to develop new anti-H. pylori therapies. The goal of this work was to evaluate the antibacterial effect of oligo-acyl-lysyl (OAK) antimicrobial peptidomimetics to determine if they might represent alternatives to conventional antibiotic treatment of H. pylori infection. A total of five OAK sequences were screened for growthinhibitory and/or bactericidal effects against H. pylori strain G27; four of these sequences had growth-inhibitory and bactericidal effects. The peptide with the highest efficacy against strain G27, C 12 K-2␤ 12 , was selected for further characterization against five additional H. pylori strains (26695, J99, 7.13, SS1, and HPAG1). C 12 K-2␤ 12 displayed MIC and minimum bactericidal concentration (MBC) ranges of 6.5 to 26 M and 14.5 to 90 M, respectively, across the six strains after 24 h of exposure. G27 was the most sensitive H. pylori strain (MIC ‫؍‬ 6.5 to 7 M; MBC ‫؍‬ 15 to 20 M), whereas 26695 was the least susceptible strain (MIC ‫؍‬ 25 to 26 M; MBC ‫؍‬ 70 to 90 M). H. pylori was completely killed after 6 to 8 h of incubation in liquid cultures containing two times the MBC of C 12 K-2␤ 12 . The OAK demonstrated strong in vitro stability, since efficacy was maintained after incubation at extreme temperatures (4°C, 37°C, 42°C, 50°C, 55°C, 60°C, and 95°C) and at low pH, although reduced killing kinetics were observed at pH 4.5. Additionally, upon transient exposure to the bacteria, C 12 K-2␤ 12 showed irreversible and significant antibacterial effects and was also nonhemolytic. Our results show a significant in vitro effect of C 12 K-2␤ 12 against H. pylori and suggest that OAKs may be a valuable resource for the treatment of H. pylori infection.Helicobacter pylori is a microaerophilic gram-negative bacterium that colonizes the gastric mucosa. It is known to be a principal gastric pathogen of humans and is associated with the development of gastritis, gastric ulcers, duodenal ulcers, and gastric cancer (46,55,56,60). Approximately half of the world's population is infected with H. pylori (79). Thus, the bacterium poses a significant public health problem, which is further compounded by the fact that H. pylori has developed antimicrobial resistance to virtually all current antibiotics, a phenomenon that is hampering efforts to treat the infection (40, 51).Since the original isolation of H. pylori in the early 1980s, treatment of the bacterial infection has undergone a significant evolutionary development from initial monotherapy to dual, triple, and in more recent trials quadruple therapy (8, 18). Current treatment strategies employ combination therapy, since single-antibiotic therapy often results in failure to eradicate the infection (21). The highest H. pylori eradication rates have been reported with triple therapy, which involves the utilization of two antibiotics in combination with bismuth or a proton pump inhibitor, PPI (34,44). Amoxicillin (amoxicil...

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A systematic comparison of triple therapies for treatment of Helicobacter pylori infection with proton pump inhibitor/ ranitidine bismuth citrate plus clarithromycin and either amoxicillin or a nitroimidazole

Cited by 79 publications

References 69 publications

Nitrofuran‐based regimens for the eradication of Helicobacter pylori infection

Nitrofuran‐based regimens for the eradication of Helicobacter pylori infection

A 10‐day levofloxacin‐based triple therapy in patients who have failed two eradication courses

In Vitro Antibacterial Activity of Acyl-Lysyl Oligomers againstHelicobacter pylori

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