Bismuth, lansoprazole, amoxicillin and metronidazole or clarithromycin as first-line<i>Helicobacter pylori</i>therapy

Zhang, Wei; Chen, Qi; Liang, Xiao; Liu, Wenzhong; Xiao, Shu–Dong; Graham, David Y.; Lü, Hong

doi:10.1136/gutjnl-2015-309900

Cited by 136 publications

(166 citation statements)

References 28 publications

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“…pylori infection (87.2%, 87.2%, 87.7%, and 86% for the ITT population and 94.1%, 91.9%, 94.8%, and 91.9% for the PP population for the LR-BAC, LR-BAT, HR-BAC, and HR-BAT groups, respectively). These results were similar to the efficacy (ITT, 88.8%; PP, 94.9%) of a 14-day quadruple-therapy regimen (including lansoprazole, bismuth, amoxicillin, and clarithromycin), as reported recently in China (18). The eradication rates of all the groups in the ITT population were higher than 85%, indicating the acceptability of these eradication regimens.…”

Section: Discussionsupporting

confidence: 90%

Ten-Day Quadruple Therapy Comprising Low-Dose Rabeprazole, Bismuth, Amoxicillin, and Tetracycline Is an Effective and Safe First-Line Treatment for Helicobacter pylori Infection in a Population with High Antibiotic Resistance: a Prospective, Multicenter, Randomized, Parallel-Controlled Clinical Trial in China

Xie

Zhu

Wang

et al. 2018

Antimicrob Agents Chemother

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Section: Discussionsupporting

confidence: 90%

Ten-Day Quadruple Therapy Comprising Low-Dose Rabeprazole, Bismuth, Amoxicillin, and Tetracycline Is an Effective and Safe First-Line Treatment for Helicobacter pylori Infection in a Population with High Antibiotic Resistance: a Prospective, Multicenter, Randomized, Parallel-Controlled Clinical Trial in China

Xie

Zhu

Wang

et al. 2018

Antimicrob Agents Chemother

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“…Approximately, 95% cure rates PP were achieved with both clarithromycin and metronidazole (figure 3). 9 The cure rate with metronidazole susceptible and resistant infections was similar (eg, approximately 90%; figure 3),9 suggesting that higher doses of metronidazole could overcome metronidazole resistance.…”

Section: Modern Experience With Triple Therapy Plus Bismuthmentioning

confidence: 98%

“…Cure rates of 14-day bismuth plus metronidazole (met) or clarithromycin (clari) triple therapy 9. The cure rates were similar with both despite relatively high prevalences of resistance (26.5% clarithromycin and 45.5% metronidazole).…”

Section: Modern Experience With Triple Therapy Plus Bismuthmentioning

confidence: 99%

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Role of bismuth in improvingHelicobacter pylorieradication with triple therapy

Dore

Lü

Graham

2016

Gut

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In most regions of the world, antimicrobial resistance has increased to the point where empirical standard triple therapy for Helicobacter pylorieradication is no longer recommended. The treatment outcome in a population is calculated as the sum of the treatment success in the subpopulation with susceptible infections plus treatment success in the subpopulation with resistant infections. The addition of bismuth (i.e., 14-day triple therapy plus bismuth) can improve cure rates despite a high prevalence of antimicrobial resistance. The major bismuth effect is to add an additional 30%-40% to the success with resistant infections. The overall result is therefore dependent on the prevalence of resistance and the treatment success in the subpopulation with resistant infections (eg, with proton-pump inhibitor-amoxicillin dual therapy). Here, we explore the contribution of each component and the mechanisms of how bismuth might enhance the effectiveness of triple therapy. We also discuss the limitations of this approach and provide suggestions how triple therapy plus bismuth might be further improved.

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“…Metronidazole resistance has remained more stable worldwide while clarithromycin resistance has increased [53]. Metronidazole resistance can also be overcome by increasing the antibiotic dose [54, 55]. Amoxicillin resistance, mediated by a variety of different mechanisms including mutations in penicillin binding proteins, decreased permeability for the antibiotic, or development of efflux pumps, is extremely rare in H. pylori [47, 56].…”

Section: Introductionmentioning

confidence: 99%

Eradication of Helicobacter pylori Infection

Marcus

Sachs

Scott

2016

Curr Gastroenterol Rep

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Helicobacter pylori infects about 50% of the world’s population, causing at a minimum chronic gastritis. A subset of infected patients will ultimately develop gastric or duodenal ulcer disease, gastric adenocarcinoma, or MALT (mucosa-associated lymphoid tissue) lymphoma. Eradication of H. pylori requires complex regimens that include acid suppression and multiple antibiotics. The efficacy of treatment using what were once considered standard regimens have declined in recent years, mainly due to widespread development of antibiotic resistance. Addition of bismuth to standard triple therapy regimens, use of alternate antibiotics, or development of alternative regimens using known therapies in novel combinations, have improved treatment efficacy in specific populations, but overall success of eradication remains less than ideal. Novel regimens under investigation either in vivo or in vitro, involving increased acid suppression ideally with fewer antibiotics or development of non-antibiotic treatment targets show promise for future therapy.

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Bismuth, lansoprazole, amoxicillin and metronidazole or clarithromycin as first-lineHelicobacter pyloritherapy

Abstract: NCT02175901.

Cited by 136 publications

References 28 publications

Role of bismuth in improvingHelicobacter pylorieradication with triple therapy

Eradication of Helicobacter pylori Infection

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