Clarithromycin Dual Therapy Regimens for Eradication of<i>Helicobacter pylori</i>: A Review

Pipkin, Graham A.; Dixon, Jonathan S.; Williamson, Russell; Wood, John R.

doi:10.1111/j.1523-5378.1997.tb00081.x

Cited by 30 publications

(38 citation statements)

References 33 publications

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“…On the other hand, recent clinical studies have shown that RBC plus clarithromycin eradicates not only clarithromycin-susceptible H. pylori, but also intermediate or even resistant strains. 18,19 Concerning the 14-day regimen, a recent review of the studies published on clarithromycin dual therapies 20 Figure 2. Eradication rates.…”

Section: Discussionmentioning

confidence: 99%

Ranitidine bismuth citrate plus clarithromycin 7‐day regimen is effective in eradicating Helicobacter pylori in patients with duodenal ulcer

Pozzato

Zagari

Cardelli

et al. 1998

Aliment Pharmacol Ther

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Background: No clinical study has been performed to‐date to evaluate the efficacy of the dual therapy of ranitidine bismuth citrate (RBC) plus clarithromycin (C) 500 mg b.d. given for 7 days for the eradication of H. pylori. Aim: To assess the eradication rates achieved by treatment with RBC 400 mg b.d. for 28 days combined with clarithromycin 500 mg b.d. for 7 days in H. pylori‐positive duodenal ulcer patients. Methods: One hundred and twelve H. pylori‐positive patients with endoscopically proven active duodenal ulcer were included in a multicentre, open, randomized trial. H. pylori infection was initially detected by CLO‐test and histology on antral and corpus biopsies, and by 13C‐urea breath test (UBT). Patients were included if at least two of the tests were positive for H. pylori infection. Patients were randomized to receive RBC 400 mg b.d. for 4 weeks combined with clarithromycin 500 mg b.d. for the first 7 days (Group A) or 14 days (Group B). A second endoscopy was performed at least 28 days after the end of therapy for the assessment of ulcer healing and H. pylori infection. Eradication was assumed if all the tests (CLO‐test, histology and UBT) were negative for H. pylori. Results: Fifty patients in Group A and 55 in Group B were assessed for H. pylori eradication and ulcer healing. The eradication rates according to intention‐to‐treat analysis were 75% in Group A and 80% in Group B. Considering only those patients with evaluable data at least 28 days after the end of therapy, H. pylori eradication was achieved in 84% and 82% in Group A and B, respectively. No statistically significant difference in eradication was found between the two groups by Mantel–Haenszel test. Only one patient, in Group A, was withdrawn because of adverse events (epigastric pain and pruritus). Conclusions: Dual therapy with RBC plus clarithromycin for 7 days could be an effective regimen for H. pylori eradication.

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Section: Discussionmentioning

confidence: 99%

Ranitidine bismuth citrate plus clarithromycin 7‐day regimen is effective in eradicating Helicobacter pylori in patients with duodenal ulcer

Pozzato

Zagari

Cardelli

et al. 1998

Aliment Pharmacol Ther

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“…In addition, like amoxicillin, the MICs are better at higher pHs such that the combination of clarithromycin and an acid-suppressive are markedly better than clarithromycin alone. However, results with dual therapies using clarithromycin with proton pump inhibitor proved variable with eradication rates ranging from 22% to 85% [28] and treatment failure typically resulted in resistance. Thus, dual therapy with a proton pump inhibitor and clarithromycin has fallen into disfavor.…”

Section: (2) Tetracyclinementioning

confidence: 97%

“…Because clarithromycin is more absorbed orally, more stable in acid, more penetrable in the tissue and more effective against H. pylori than erythromycin (Table 1) [24], it has been used in many eradication regimens. The eradication rates of monotherapies with clarithromycin are in the range of 10% to 42% [25][26][27][28].…”

Section: (4) Macrolidesmentioning

confidence: 99%

Strategy for Treatment of Helicobacter pylori Infection in Adults II. Practical Policy in 2000

Nakajima

Graham²,

Hattori³

et al. 2000

CPD

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The approach to the patient with suspected H. pylori infection consists of an adequate indication to test for the presence of the infection, choice of an appropriate antimicrobial regimen, and education about its use and side effects, followed by post-therapy testing to confirm cure. We review the drugs and regimens for H. pylori eradication and present a strategy for treating the infection. The major factor in choosing an antibiotic regimen is the pattern of antibiotic resistance in the community. Triple therapy with a proton pump inhibitor (PPI) or ranitidine bismuth citrate (RBC) and two antimicrobials is recommended as the first choice regimen. In regions where metronidazole and clarithromycin resistance are common, initial therapy with quadruple therapy consisting of bismuth, metronidazole, tetracycline, and a PPI is recommended. In general, higher doses and longer durations are associated with better outcomes. For this reason we recommend that the minimum duration of 10 days and we prefer 14 days. The actual choice of the antimicrobial combination will also be influenced by the drugs approved by the local regulatory bodies. Side effects, eradication failure and current as well as future designs of eradication therapies are also discussed.

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“…9,31,32,39 Some studies find that ranitidine bismuth citrate plus one antibiotic gives good eradication rates. 30,33 Quadruple therapies (a PPI, plus two antibiotics, plus a bismuth compound) seem equally or less efficacious than triple combinations. 29,34,35 Some studies find H 2 receptor antagonist-based triple therapies (an H 2 receptor antagonist plus two antibiotics) less effective, 27,32 whilst others find it equally effective.…”

Section: Drug Therapy For Eradication Of Helicobacter Pylorimentioning

confidence: 99%

“…PPI-based dual therapies (a PPI plus one antibiotic) give lower eradication rates than PPI-based triple therapies. 25,27,29,[31][32][33][37][38][39] Results are poorly reproducible. 31 The antibiotic used can markedly affect effectiveness, e.g.…”

Section: Drug Therapy For Eradication Of Helicobacter Pylorimentioning

confidence: 99%

The management of Helicobacter pylori infection in primary care: a systematic review of the literature

Childs

Roberts²,

Meineche-Schmidt³

et al. 2000

Family Practice

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Childs SM, Roberts AP, Meineche-Schmidt V, de Wit NJ and Rubin GP. The management of Helicobacter pylori infection in primary care: a systematic review of the literature. Family Practice 2000; 17: S6-S11. Objective. The aim of the present study was to provide evidence from the literature to inform the production of guidelines by the European Society for Primary Care Gastroenterology (ESPCG) for the management of Helicobacter pylori infection in primary care. Methods. A systematic review was conducted, searching MEDLINE, EMBASE and the Cochrane Library. The systematic review was designed to answer a number of questions: the role of H.pylori in the aetiology of peptic ulcer disease (PUD), gastric cancer (GC), non-ulcer dyspepsia (NUD) and oesophagitis; non-invasive testing for H.pylori and post-treatment testing; eradication therapy; and cost issues. Selection of records concentrated on the highest quality studies, i.e. systematic reviews, meta-analyses and cost analyses. Results.Helicobacter pylori infection is a causal factor in PUD and GC but not in NUD or oesophagitis. Serological tests and urea breath tests (UBTs) can be used for the detection of H.pylori, but UBT is the preferred choice for post-treatment testing. Proton pump inhibitor (PPI)-based triple regimens are the preferred eradication therapy. Eradication therapy is more costeffective than long-term maintenance therapy.Conclusions. Strong evidence is available for answering questions on the aetiology of stomach ulcers and GU, eradication therapies and cost issues. Weaker evidence is available for answering the questions on the aetiology of NUD and non-invasive testing. No evidence is available for answering the question on the role of H.pylori in the aetiology of oesophagitis.

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Clarithromycin Dual Therapy Regimens for Eradication ofHelicobacter pylori: A Review

Abstract: High H. pylori eradication rates derived by consistent and clearly defined methods have been seen with ranitidine bismuth citrate plus clarithromycin. Lower and more variable rates are reported with clarithromycin and either a proton pump inhibitor or a histamine H2-receptor antagonist.

Cited by 30 publications

References 33 publications

Ranitidine bismuth citrate plus clarithromycin 7‐day regimen is effective in eradicating Helicobacter pylori in patients with duodenal ulcer

Ranitidine bismuth citrate plus clarithromycin 7‐day regimen is effective in eradicating Helicobacter pylori in patients with duodenal ulcer

Strategy for Treatment of Helicobacter pylori Infection in Adults II. Practical Policy in 2000

The management of Helicobacter pylori infection in primary care: a systematic review of the literature

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