A Triple and Quadruple Therapy with Doxycycline and Bismuth for First‐Line Treatment of <i><scp>H</scp>elicobacter pylori</i> Infection: A Pilot Study

Ciccaglione, Antonio Francesco; Cellini, Luigina; Grossi, Laurino; Manzoli, Lamberto; Marzio, L.

doi:10.1111/hel.12209

Cited by 23 publications

(21 citation statements)

References 49 publications

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“…There is a suggestion that high dose doxycycline therapy might be effective but this approach has not been tested in relation to metronidazole resistance [49]. It is our experience, doxycycline provides poor cure rates when substituted of tetracycline in regions with metronidazole resistance and we suggest that it be avoided unless new susceptibility-based data shows that it can be used effectively in the presence of metronidazole resistance (discussed in detail in reference [46]).…”

Section: Bismuth Quadruple Therapymentioning

confidence: 98%

Helicobacter pyloritherapy: a paradigm shift

Graham

Dore

2016

Expert Review of Anti-infective Therapy

108

124

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SUMMARY Helicobacter pylori (H. Pylori) is a leading cause of gastroduodenal disease, including gastric cancer. H. pylori eradication therapies and their efficacy are summarized. A number of current treatment regimens will reliably yield >90% or 95% cure rates with susceptible strains. None has proven to be superior. We show how to predict the efficacy of a regimen in any population provided one knows the prevalence of antibiotic resistance. As with other infectious diseases, therapy should always be susceptibility-based. Susceptibility testing should be demanded. We provide recommendations for empiric therapies when the only option and describe how to distinguish studies providing misinformation from those providing reliable and interpretable data. When treated as an infectious disease, high H. pylori cure rates are relatively simple to reliably achieve.

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Section: Bismuth Quadruple Therapymentioning

confidence: 98%

Helicobacter pyloritherapy: a paradigm shift

Graham

Dore

2016

Expert Review of Anti-infective Therapy

108

124

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“…Most available doxycycline data relates to substitution of doxycycline for tetracycline and amoxicillin for metronidazole all given b.i.d. 61-63 (Table 3). The three studies from Italy suggest that this might be an effective regimen whereas the one from China did not.…”

Section: Doxycyclinementioning

confidence: 99%

“…The use of stopping rules allows most efficient use of resources and has been used successfully with bismuth quadruple therapy 63 .…”

Section: Efficient Study Designmentioning

confidence: 99%

How to Effectively Use Bismuth Quadruple Therapy

Graham

Lee

2015

Gastroenterology Clinics of North America

134

174

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Bismuth triple therapy was the first truly effective Helicobacter pylori eradication therapy. The addition of a proton pump inhibitor largely overcame the problem of metronidazole resistance. Resistance to its being the primary first line therapy have centered on convenience (the large number of tablets required) and side effects causing difficulties with patient adherence. Understanding why the regimen is less successful in some regions remains unexplained in part because of the lack of studies including susceptibility testing. A number of modifications have been proposed such as twice-a-day therapy which addresses both major criticism but the studies with susceptibility testing required to prove its effectiveness in high metronidazole resistance areas are lacking. Most publications lack the data required to understand why they were successful or failed (e.g., detailed resistance and adherence data) and are therefore of little value. We discuss and provide recommendations regarding variations including substitution of doxycycline, amoxicillin, and twice a day therapy. We describe what is known and unknown and provide suggestions regarding what is needed to rationally and effectively use bismuth quadruple therapy. Its primary use is when penicillin cannot be used or when clarithromycin and metronidazole resistance is common. Durations of therapy less than 14 days are not recommended.

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“…When doxycycline was used as first‐line therapy in different studies, the eradication rates ranged from 36%‐61% in triple therapies and 59.3%‐92.1% in quadruple therapies . As second‐line or third‐line rescue therapies, the eradication rates of triple therapies were similarly low (ranging from 0%‐40%), while the efficacies of quadruple therapies were between 67.4% and 91% .…”

Section: Discussionmentioning

confidence: 99%

Bismuth, rabeprazole, amoxicillin, and doxycycline as first‐line Helicobacter pylori therapy in clinical practice: A pilot study

Chen

et al. 2019

Helicobacter

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Background Bismuth‐containing quadruple therapy (BQT) is a recommended alternative first‐line therapy for Helicobacter pylori (H. pylori) infection. We aim to evaluate the efficacy and safety of a new BQT with amoxicillin and doxycycline as a first‐line treatment for H. pylori infection in clinical practice. Methods An open, prospective pilot clinical study including H. pylori‐positive outpatients who had never received eradication treatment was carried out. An RADB regimen (10 mg rabeprazole, 1000 mg amoxicillin, 100 mg doxycycline, and 220 mg colloidal bismuth tartrate, all given bid for 14 days) was prescribed by gastroenterologists. H. pylori eradication was confirmed by a 13C‐urea breath test performed at least 6 weeks after the end of treatment. Regimen efficacy was evaluated by per‐protocol (PP) and intention‐to‐treat (ITT) analyses. Results One hundred eighteen patients were included in the study. The eradication rate of RADB was 93.8% (105/112; 95% CI 89.2%‐98.3%) in PP analysis and 89.8% (106/118; 95% CI 84.3%‐95.4%) in ITT analysis. The patient compliance rate was 97.5% (115/118). The adverse event rate was 6.8% (8/118). Adverse events included asthenia, loss of appetite, dry mouth, heartburn, diarrhea, and abdominal pain. All adverse events disappeared after completion of therapy. Conclusion Our results suggest that 14‐day BQT with amoxicillin and doxycycline can be an effective and safe eradication regimen for first‐line therapy against H. pylori infection in clinical practice.

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A Triple and Quadruple Therapy with Doxycycline and Bismuth for First‐Line Treatment of Helicobacter pylori Infection: A Pilot Study

Cited by 23 publications

References 49 publications

Helicobacter pyloritherapy: a paradigm shift

Helicobacter pyloritherapy: a paradigm shift

How to Effectively Use Bismuth Quadruple Therapy

Bismuth, rabeprazole, amoxicillin, and doxycycline as first‐line Helicobacter pylori therapy in clinical practice: A pilot study

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