Addition of Metronidazole to Rabeprazole‐Amoxicillin‐Clarithromycin Regimen for <i>Helicobacter pylori</i> Infection Provides an Excellent Cure Rate with Five‐Day Therapy

Nagahara, Akihito; Miwa, Hiroto; Ogawa, Kaoru; Kurosawa, Akihiko; Ohkura, Ryuichi; Iida, Noboru; Sato, Nobuhiro

doi:10.1046/j.1523-5378.2000.00013.x

Cited by 58 publications

(42 citation statements)

References 25 publications

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“…In the present study, there was not significant relationship between the H. pylori eradication rate and gender in any of the therapeutic groups. The result of current research is similar to the results of Khalilian et al, 17 and Chan et al, Studies 19 . In the present study, education level and smoking were also examined and no relationships were observed between education level, smoking and the H. pylori eradication rate.…”

Section: Discussionsupporting

confidence: 91%

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2017

IJPSR

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There are various treatment regimens including different antibiotics and antacid medications for eradicating Helicobacter pylori to compare the effectiveness of 7-day concomitant regime with classic triple regimen in eradicating H. pylori. In this randomized clinical trial, 206 dyspeptic patients proven H. pylori infection, attended to a gastrointestinal clinic in Khorramabad (west of Iran) were studied. The patients were randomly divided in two equal groups. Classic group were treated for 14 days with a regimen including omeprazole 20mg, amoxicillin 1g and clarithromycin 500mg, twice daily. In concomitant group, the patients were treated for 7 days with a regimen including omeprazole 20mg, amoxicillin 1g, clarithromycin 500mg and metronidazole 500mg twice daily. During the treatment period and a week after the end of treatment, the patients were evaluated in terms of possible side-effects and medication acceptance and tolerance. For confirmation of eradication, 6 weeks after the end of treatment, urea breath test with carbon 13 (UBT) was done for both the groups. Data were analyzed using descriptive statistics, T-test and chi-square test, logistic regression through SPSS software version 21. The level of significance was considered less than 0.05. H. pylori eradication rate in classic group was 68.9% and in concomitant group was 83.4%. (p -value = 0.03). The incidence of gastrointestinal side-effects was not statistically different between the groups. H. pylori eradication rate in 7-day concomitant treatment regimen is more than 14-day classic regimens. Therefore, it is suggested to use 7-day concomitant regimen as first-line of H. pylori eradication.

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Section: Discussionsupporting

confidence: 91%

“…In the studies of Khalilian et al, 17 and Naghara et al, 18 no significant relationship between the age groups and the treatment success of H. pylori was observed. In the present study, there was not significant relationship between the H. pylori eradication rate and gender in any of the therapeutic groups.…”

Section: Discussionmentioning

confidence: 89%

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2017

IJPSR

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“…It consists of all four drugs (the PPI, clarithromycin, metronidazole/ tinidazole, and amoxicillin being given b.i.d.. The duration has ranged from 3 to 7 days and it has resulted in Grade B results similar to those obtained with sequential therapy [59][60][61][62][63][64][65][66][67] ( Figure 3). As with sequential therapy, studies are needed to test whether extending the duration of therapy will improve the results.…”

Section: Treatment Recommendations For Initial Treatmentmentioning

confidence: 99%

“…From reference 14 , with permission. Weight mean and 95% confidence intervals for 16 studies of sequential therapy (n = 1805) for 10 days(modified intention-to-treat) 57 and 9 studies of concomitant therapy (n = 715) ranging from 3 to 7 days (intention-to-treat) [59][60][61][62][63][64][65][66][67] .…”

Section: Key Pointsmentioning

confidence: 99%

New concepts of resistance in the treatment of Helicobacter pylori infections

Graham

Shiotani

2008

Nat Rev Gastroenterol Hepatol

316

368

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SummaryThe prevalence of antimicrobial resistance is now such that all patients should be considered as having resistant infections. Ideally therapy is based on pretreatment susceptibility testing. Empiric therapies should assume antimicrobial resistance and use higher doses for 14 days. Acceptable results are 90-94% cure intention to treat (Grade B) or greater. Clarithromycin-containing triple therapies now typically produce ≤80% cure ITT (Grade F) and are no longer acceptable empiric therapy. Current initial therapy options are between sequential therapy, concomitant therapy, and bismuth containing quadruple therapy. Sequential therapy has the potential to be improved to ≥95% cure ITT (Grade A) by continuing the amoxicillin through the second and/or by increasing the duration. Better appreciation of the role of acidity in phenotypic resistance has resulted in high cure rates with high dose PPI plus amoxicillin dual therapy; additional studies to devise better dual-based multidrug regimes are still needed. Antimicrobial choices following treatment failure is best approached by susceptibility testing. If not available, we recommended a bismuth containing quadruple therapy substituting a new drug for metronidazole/tinidazole and/or clarithromycin if they have been used previously. The alternate would be to use a 14 day high dose PPI, amoxicillin-based triple therapy with rifabutin, a fluoroquinolone, or furazolidone. KeywordsHelicobacter pylori; therapy; resistance; antibiotics; anti-secretory drugs; phenotypic drug resistance; cytochrome P450 "To read without reflecting is like eating without digesting". -86-462-1111-86-462- , FAX 81-86-464-1195 Review criteria: We searched the relevant papers by using computer-assisted bibliographic searches of PubMed through November 30, 2007 using combinations of the following terms: H. pylori combined with resistance, therapy, eradication, second, triple, quadruple, sequential, or rescue. We also reviewed the recent literature on pharmacokinetics and pharmacodynamics in relation to the drugs used in H. pylori therapy and the relation to host cytochrome P450 genotypes to treatment outcome. We did not perform meta-analyses. We reviewed only articles published in English.

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“…8 It has a very potent and long-acting antisecretory property, and a greater antibacterial effect than either omeprazole or lansoprazole. 9 Although rabeprazole 20 mg/day seems to effectively eradicate H. pylori infection in a Japanese population, [10][11][12][13][14] only three of the studies directly investigated the comparative efficacy of 20 and 40 mg/day of rabeprazole. 10,13,14 The dosage of clarithromycin used in all these trials was 200 mg b.d., and the cure rate varied from 85 to 94%.…”

Section: Introductionmentioning

confidence: 99%

Low and high doses of rabeprazole vs. omeprazole for cure of Helicobacter pylori infection

Kositchaiwat

Ovartlarnporn

Kachintorn

et al. 2003

Aliment Pharmacol Ther

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SUMMARYBackground: Low-dose rabeprazole-based triple therapy was effective for Helicobacter pylori eradication in a few Japanese studies. Aim: To compare the effectiveness of 1-week low-dose and high-dose rabeprazole-based triple therapy with those of omeprazole. Methods: One hundred and sixty-two H. pylori-infected dyspeptic patients were randomized to receive twice daily for 1 week either rabeprazole 10 mg (R 10 ), rabeprazole 20 mg (R 20 ) or omeprazole 20 mg (O) in combination with amoxicillin 1000 mg (A) and clarithromycin 500 mg (C). H. pylori status assessment was by the CLO test and histology at entry and by the

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Addition of Metronidazole to Rabeprazole‐Amoxicillin‐Clarithromycin Regimen for Helicobacter pylori Infection Provides an Excellent Cure Rate with Five‐Day Therapy

Abstract: The simple twice-daily and short-term quadruple regimen for only 5 days provided an excellent eradication rate. Compliance with the regimen was high, and serious adverse effects were few. Therefore, the RACM regimen can be considered as safe and effective.

Cited by 58 publications

References 25 publications

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New concepts of resistance in the treatment of Helicobacter pylori infections

Low and high doses of rabeprazole vs. omeprazole for cure of Helicobacter pylori infection

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