Amoxicillin/Metronidazole/Omeprazole/Clarithromycin: A New, Short Quadruple Therapy for <i>Helicobacter pylori</i> Eradication

Treiber, Gerhard; Ammon, Susanne; Schneider, Erich; Klotz, Ulrich

doi:10.1046/j.1523-5378.1998.08019.x

Cited by 103 publications

(87 citation statements)

References 12 publications

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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%

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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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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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“…The superiority of this therapy over standard triple therapy has been widely documented (7). Meanwhile, concomitant therapy, first introduced in 1998 (8,9), is now being reconsidered as a firstline H. pylori eradication therapy (10). The concomitant regimen includes quadruple therapy with standard triple therapy (PPI, clarithromycin, amoxicillin) plus metronidazole or tinidazole.…”

Section: Introductionmentioning

confidence: 99%

Meta-Analysis of Sequential, Concomitant and Hybrid Therapy for <i>Helicobacter pylori</i> Eradication

Deng

Luo

2015

Intern. Med.

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Objective To compare the efficacy of sequential therapy, concomitant therapy and hybrid therapy for the treatment of Helicobacter pylori (H. pylori) infection. Methods PubMed, Web of Science, Medline, Embase, the Cochrane Central Register of Controlled Trials and CNKI were searched up to the end of May 10, 2014 in order to identify all randomized controlled trials (RCTs) reporting the effects of sequential therapy, concomitant therapy and hybrid therapy on H. pylori eradication. The relative risk (RR) of eradicating H. pylori infection after sequential therapy compared with concomitant therapy or hybrid therapy was pooled. The eradication rates were considered both on an intention-to-treat (ITT) and per-protocol (PP) basis. Results A total of 10 RCTs involving 3,501 patients were included. The pooled data suggested that the differences between the three groups were not statistically significant (ITT analysis: sequential therapy vs. concomitant therapy: RR=1.01, 95%confidence interval (CI): 0.97-1.04, sequential therapy vs. hybrid therapy: RR=1.02, 95%CI: 0.85-1.22, concomitant therapy vs. hybrid therapy: RR=1.03, 95%CI: 0.97-1.08; PP analysis: sequential therapy vs. concomitant therapy: RR=1.00, 95%CI: 0.96-1.03, sequential therapy vs. hybrid therapy: RR=0.97, 95%CI: 0.86-1.09, concomitant therapy vs. hybrid therapy: RR=1.01, 95%CI: 0.93-1.10). In the ITT and PP analyses, the overall eradication rates were 84.3% (95%CI: 79.1-89.4) and 86.4% (95%CI: 81.7-91.0) for the sequential therapy group, 86.7% (95%CI: 81.0-92.3) and 89.8% (95%CI: 85.1-94.5) for the concomitant therapy group and 86.6% (95%CI: 82.3-91.0) and 92.7% (95%CI: 90.5-94.9) for the hybrid therapy group, respectively. There were no significant differences among these therapies in terms of the rate of side effects. Conclusion The pooled evidence suggests that sequential therapy, concomitant therapy and hybrid therapy are similar with respect to the treatment of H. pylori infection.

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“…The ®rst experience with RBC combined with clarithromycin and metronidazole for 1 week was published 2 years ago by our group in a small, but randomized and controlled study. 2 We obtained eradication rates higher than 85% on ITT with metronidazole 500 mg b.d. and a low dosage of clarithromycin (250 mg b.d.).…”

mentioning

confidence: 71%

“…They were not aware of a randomized controlled trial demonstrating no signi®-cant ITT-differences between the 5-day quadruple (90%) and the 7-day triple (91%) regimen, using omeprazole instead of lansoprazole. 2 We have extended our work, comparing the same 5-day CALM with a 5-day CARM (replacing lansoprazole (L) 30 mg b.d. with ranitidine (R) 300 mg (b.d.)…”

mentioning

confidence: 99%

Reply — Efficacy of 1‐week ranitidine‐ bismuth‐citrate (RBC)‐based triple therapy for eradication of Helicobacter pylori infection

Hoffman

1999

Aliment Pharmacol Ther

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Ef®cacy of 1-week ranitidine-bismuth-citrate (RBC)-based triple therapy for eradication of Helicobacter pylori infection SIRS, We read the recent article by Hoffman et al. on the evaluation of a RBC-based triple regimen administered for only 1-week to eradicate Helicobacter pylori infection.1 They obtained excellent eradication rates (86% with ITT and 91% with PP) on a small number of patients (n 50) and therefore emphasize the effectiveness of this short-term triple therapy. The authors present their study as an original one, because they hypothesized that adding an inexpensive antibiotic (metronidazole) to the FDA-approved double regimen based on RBC 400 mg b.d. and clarithromycin 500 mg b.d., and giving these drugs only twice daily and for half the time commonly used in USA (7 instead of 14 days), would have improved its ef®cacy. Unfortunately, they seem not to be aware of the fact that this regimen has been already assessed and found to be excellent in a great number of previous studies. The ®rst experience with RBC combined with clarithromycin and metronidazole for 1 week was published 2 years ago by our group in a small, but randomized and controlled study. con®rmed our excellent results on larger series and nowadays the good performance of this new 1-week RBC-based regimen can be considered consolidated, as con®rmed by a recent paper showing the results of many studies using this therapeutic scheme.5 By pooling together all these trials, Pipkin et al. show that RBC-based triple therapy allows us to achieve high and consistent eradication rates, which are similar to those of proton pump inhibitor-based triple regimens. We are greatly surprised that Hoffman and co-workers did not mention at all in their article the above clinical trials. We think that the quality and relevance of their study are greatly reduced by several important methodological¯aws (lack of randomization and control) and by the apparent ignorance of the already published literature in this ®eld. V. SAVARINO & S. VIGNERI*

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Amoxicillin/Metronidazole/Omeprazole/Clarithromycin: A New, Short Quadruple Therapy for Helicobacter pylori Eradication

Abstract: Five-day quadruple therapy (with omeprazole, metronidazole, clarithromycin and amoxicillin) represents an effective and safe new regimen for H. pylori eradication.

Cited by 103 publications

References 12 publications

New concepts of resistance in the treatment of Helicobacter pylori infections

New concepts of resistance in the treatment of Helicobacter pylori infections

Meta-Analysis of Sequential, Concomitant and Hybrid Therapy for <i>Helicobacter pylori</i> Eradication

Reply — Efficacy of 1‐week ranitidine‐ bismuth‐citrate (RBC)‐based triple therapy for eradication of Helicobacter pylori infection

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