Bismuth-based Quadruple Therapy Following H. pylori Eradication Failures: a Multicenter Study in Clinical Practice

Zullo, Angelo; Francesco, Vincenzo De; Bellesia, Annamaria; Vassallo, Roberto; D’Angelo, Audenzio; Scaccianoce, Giuseppe; Sacco, Rodolfo; Bresci, G.; Eramo, A.; Tanzilli, Anna; Alvaro, Domenico; Londoni, C.; Brambilla, Gianfranco; Manta, Raffaele; Ciaula, Agostino Di; Portincasa, Piero

doi:10.15403/jgld.2014.1121.263.zul

Cited by 18 publications

(19 citation statements)

References 18 publications

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“…Noteworthy, the success rate of such a therapy remained acceptably high until it was used as fourth‐line regimen, while it dropped to low values (<67%) only in those patients with more than 4 therapy failures. Such finding is in agreement with the results of a recent multicenter, Italian study where the success rate fell to 67% after 4 or more therapy failures . Therefore, such phenomenon deserves further investigation.…”

Section: Discussionsupporting

confidence: 92%

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Rescue therapy with bismuth quadruple regimen in patients with Helicobacter pylori ‐resistant strains

et al. 2017

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Section: Discussionsupporting

confidence: 92%

“…Finally, we administered the therapy for 10 days, and a longer 14‐day regimen should be tested. However, high eradication rates were achieved in using the same 10‐day regimen in three recent Italian studies, and in multicenter, European study …”

Section: Discussionmentioning

confidence: 96%

Rescue therapy with bismuth quadruple regimen in patients with Helicobacter pylori ‐resistant strains

et al. 2017

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“…Although this study analyzed data of patients who underwent 7-day METbased second-line BQT, recent guidelines on H. pylori eradication therapy recommend 10-or 14-day, rather than 7-day, eradication for H. pylori. Several studies have showed results consistent with these guidelines [27,40].…”

Section: Discussionmentioning

confidence: 80%

Impact of previous metronidazole exposure on metronidazole-based second-line quadruple therapy for Helicobacter pylori infection

Lee

Shin

et al. 2020

Korean J Intern Med

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Background/Aims: The negative effects on the eradication success of Helicobacter pylori infection after previous exposure to macrolides, including clarithromycin on clarithromycin-based first-line therapy have been demonstrated. However, whether this is true for metronidazole-based second-line quadruple therapy remains unclear. We investigated the relationship between past administration of metronidazole and the failure of metronidazole-based second-line quadruple therapy in patients with H. pylori infection. Methods: Patients over 20 years of age who were diagnosed with H. pylori infection between January 1998 and March 2016 were enrolled in this study. The relationship between the clinical parameters and the results of a C13-urea breath test after metronidazole-based second-line quadruple therapy was analyzed in patients for whom clarithromycin-based triple therapy failed to eradicate H. pylori. Results: The H. pylori eradication failure rate was significantly higher in patients with a history of metronidazole use than in patients without a history of metronidazole use (p = 0.011). Multivariable analysis showed that the odds ratio of previous metronidazole use for eradication failure was 3.468 (95% confidence interval, 1.391 to 8.649; p = 0.008). In the subgroup analysis of patients with a history of metronidazole use, the duration of metronidazole use and interval between its use and eradication therapy did not significantly affect H. pylori eradication failure. Conclusions: Previous exposure to metronidazole was a significant risk factor for treatment failure of metronidazole-based second-line quadruple therapy; therefore, this should be considered when establishing a treatment strategy for patients with H. pylori infection.

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“…Another finding that emerged from our study was that both therapeutic regimens were safe. The incidence of TEAEs of the bismuth plus omeprazole‐based quadruple regimen has already been well assessed in previous studies and varied from 26.7% to 67% of treated cases . In addition, the incidence of TEAEs was similar to those recorded with other eradicating therapies.…”

Section: Discussionmentioning

confidence: 57%

Pylera® plus ranitidine vs Pylera® plus esomeprazole in first‐line treatment of Helicobacter pylori infection: Two pilot studies

2019

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Background: Several studies have shown that Pylera ® (three-in-one capsules containing 140 mg bismuth potassium subcitrate, 125 metronidazole, and tetracycline 125 mg) in association with omeprazole or esomeprazole is a good option in the treatment of Helicobacter pylori infection. In particular, the adjunction of a PPI to Pylera ® may be useful to overcome metronidazole resistance. However, omeprazole and its derivatives can promote greater bismuth absorption and enhance its toxicity.The H2 receptor antagonist (H2RA) ranitidine seems to induce less bismuth absorption and as a consequence less systemic toxicity. Aim:To evaluate whether Pylera ® in combination with esomeprazole or with ranitidine is equally effective in the treatment of H. pylori infection. Material and Methods:Two separate groups of patients were treated simultaneously.One group was treated with Pylera ® three capsules qid plus esomeprazole 40 mg bid for 10 days (group A), and the other group was treated with Pylera ® three capsules qid plus ranitidine 300 mg bid for 10 days (group B). H. pylori eradication was defined as a negative result in 13 C urea breath test performed at least 8 weeks after the end of treatment with a delta-over-baseline value less than 5.Results: Thirty-two patients were recruited for group A and thirty-three patients in group B. Eradication rates were 93.7% (30/32) and 90.9% (30/33), respectively, at intention-to-treat analysis, and 96.6% (29/30) and 93.3% (28/30), respectively, at perprotocol analysis. Adverse events occurred in 26 patients and led to the suspension of treatment in one patient in group A and in one patient in group B. Conclusion:The results showed that Pylera® plus a PPI or ranitidine were equally effective in the population studied. The high cure rates of bismuth triple therapy (without an antisecretory drug) and the lack of susceptibility testing make it impossible to exclude the possibility that the results would have been similar if neither the PPI nor the ranitidine were given. K E Y W O R D Sesomeprazole, first-line therapy, Helicobacter pylori infection, Pylera ® , Ranitidine

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Bismuth-based Quadruple Therapy Following H. pylori Eradication Failures: a Multicenter Study in Clinical Practice

Abstract: Our study found that this bismuth-based quadruple therapy is highly effective as second-line and rescue therapy for H. pylori eradication in clinical practice.

Cited by 18 publications

References 18 publications

Rescue therapy with bismuth quadruple regimen in patients with Helicobacter pylori ‐resistant strains

Rescue therapy with bismuth quadruple regimen in patients with Helicobacter pylori ‐resistant strains

Impact of previous metronidazole exposure on metronidazole-based second-line quadruple therapy for Helicobacter pylori infection

Pylera® plus ranitidine vs Pylera® plus esomeprazole in first‐line treatment of Helicobacter pylori infection: Two pilot studies

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