Comparison of sequential and 7-, 10-, 14-d triple therapy for<i>Helicobacter pylori</i>infection

Choi, Hyuk Soon; Chun, Hoon Jai; Park, Sanghoon; Keum, Bora; Seo, Yeon Seok; Kim, Yong Sik; Jeen, Yoon Tae; Um, Soon Ho; Lee, Hong Sik; Kim, Chang Duck; Ryu, Ho Sang

doi:10.3748/wjg.v18.i19.2377

Cited by 59 publications

(54 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Full-text of the seven remaining articles was reviewed and one article was removed. The remaining six RCTs were eligible for meta-analysis 10-15…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Sequential Therapy for Helicobacter pylori Infection in Korea: Systematic Review and Meta-Analysis

Kim¹,

Kim²,

Ham³

et al. 2013

Gut Liver

View full text Add to dashboard Cite

Background/AimsSequential therapy (ST) for Helicobacter pylori infection in countries other than Korea has shown higher eradication rates than triple therapy (TT). The aim of this study was to evaluate the efficacy of ST in Korea by performing a meta-analysis.MethodsWe performed a comprehensive literature search on the efficacy of ST as a first-line therapy. The odds ratios (ORs) of eradicating H. pylori infection after ST compared with TT were pooled. Pooled estimates of the eradication rates of ST and TT were also calculated.ResultsA total of six studies provided data on 1,759 adult patients. The ORs for the intention to treat (ITT) and the per-protocol (PP) eradication rate were 1.761 (95% confidence interval [CI], 1.403 to 2.209) and 1.966 (95% CI, 1.489 to 2.595). Pooled estimates of the ITT and PP eradication rate were 79.4% (95% CI, 76.3% to 82.2%) and 86.4% (95% CI, 83.5% to 88.8%), respectively, for the ST group, and 68.2% (95% CI, 62.1% to 73.8%) and 78.9% (95% CI, 68.9% to 81.7%), respectively, for the TT group.ConclusionsAlthough ST presented a higher eradication rate than TT in Korea, the pooled eradication rates were lower than expected. Further studies are needed to validate ST as a first-line treatment for H. pylori in Korea.

show abstract

“…Full-text of the seven remaining articles was reviewed and one article was removed. The remaining six RCTs were eligible for meta-analysis 10-15…”

Section: Resultsmentioning

confidence: 99%

“…We considered RCTs with a score of 3 or greater to be high quality. In one RCT, participants of the TT group were randomly assigned to three groups according to treatment duration: 7-, 10-, and 14-day regimens 10. Since the object of our review was to compare ST with TT, we combined all the TT therapy arms into a single TT group.…”

Section: Methodsmentioning

confidence: 99%

Sequential Therapy for Helicobacter pylori Infection in Korea: Systematic Review and Meta-Analysis

Kim¹,

Kim²,

Ham³

et al. 2013

Gut Liver

View full text Add to dashboard Cite

show abstract

“…A randomized-controlled study published in 2007 indicated no difference of eradication rate between 7 days-regimen and 14 days-regimen (intention-to-treat [ITT] analysis: 71.2% and 75.5%, respectively) [25]. Another study published in 2012 also demonstrated no significant difference among 7 days-, 10-days, and 14-days regimens (ITT analysis: 70.4%, 74.7%, and 80.0% respectively, P=0.244) [26]. Although the current guideline still recommends the conventional triple therapy for 7 to 14 days as first-line H. pylori eradication therapy, clinicians should be cautious for treating H. pylori infection with the conventional triple therapy.…”

Section: Conventional Triple Therapymentioning

confidence: 93%

“…In 2011, sequential therapy for 10 days was shown to be superior to conventional triple therapy for 14 days (ITT analysis: 85.9% vs. 75.0%, P=0.006) [37]. In 2012, three studies were published, and two of them demonstrated superior efficacy of sequential therapy compared to conventional triple therapy for 7 days (ITT analysis: 62.2% vs. 77.8%, P=0.002; 63.0% vs. 79.3%, P=0.005) [38,39], while the remaining one did not show statistical difference of eradication rate among sequential therapy and various triple therapy regimens (ITT analysis: sequential therapy vs. 7 days-triple therapy vs. 10 days-triple therapy vs. 14 days-triple therapy, 75.6% vs. 70.4% vs. 74.7% vs. 80.0%, P=0.416) [26]. In 2016, a nationwide multi-center randomizedcontrolled trial showed that sequential therapy had better eradication rate than conventional triple therapy as a first-line treatment of H. pylori infection (ITT analysis: 82.4% vs. 70.8%, P=0.001) [40].…”

Section: Sequential Therapymentioning

confidence: 99%

The first-line regimens of Helicobacter pylori eradication in Korea

Park

2017

Hanyang Med Rev

View full text Add to dashboard Cite

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.Approximately half of the world's population is infected by Helicobacter pylori, which causes various gastrointestinal diseases including gastritis, peptic ulcer, gastric mucosa-associated lymphoid tissue lymphoma, and gastric cancer. The conventional triple therapy, that consists of proton pump inhibitor (PPI), amoxicillin, and clarithromycin, is widely used in Korea because of high resistance rates of H. pylori against metronidazole. Recently, however, clarithromycin-resistance rates have also increased and the eradication rate of conventional triple therapy has been unacceptable. In order to increase the eradication rate of H. pylori, various regimens have been suggested. Understanding H. pylori eradication regimens will help select drugs in the management of H. pylori infection.

show abstract

“…However, as the failure rate of the 7-day triple therapy has increased progressively, sequential or concomitant therapy has come to be used (3,5). Unfortunately, the 7-day triple therapy is still regarded as the standard primary therapy in South Korea because there is no proven alternative regimen that can provide more efficient and safer eradication (6,7). The unsatisfactory response of alternative eradication regimens was mainly caused by antimicrobial resistance and was particularly due to clarithromycin resistance (5,8).…”

mentioning

confidence: 99%

High Efficacy of Finafloxacin on Helicobacter pylori Isolates at pH 5.0 Compared with That of Other Fluoroquinolones

Lee

Kim

Nam

et al. 2015

Antimicrob Agents Chemother

View full text Add to dashboard Cite

Finafloxacin is a novel fluoroquinolone with improved antimicrobial efficacy, especially in an acidic environment. The efficacy of finafloxacin for the inhibition of Helicobacter pylori infection was compared with the efficacies of levofloxacin and moxifloxacin at neutral and acidic pH. The impacts of gyrA point mutation on the efficacy of those three fluoroquinolones were also investigated. A total of 128 clinical H. pylori strains were utilized. MICs of levofloxacin, moxifloxacin, and finafloxacin were determined at pH 5.0 and pH 7.0 by the agar dilution method. The impact of gyrA point mutations that are responsible for fluoroquinolone resistance was analyzed; the results showed 50 strains with an Asn-87 point mutation, 48 strains with an Asp-91 point mutation, and the remaining 30 strains with no gyrA mutations. The use of finafloxacin led to MIC values at pH 5.0 that were lower than the values seen at pH 7.0 for 112 strains (112/128, 87.5%), and this proportion was higher than that seen with moxifloxacin (21/128, 16.4%, P < 0.001). Finafloxacin also demonstrated a rate of susceptibility (MIC, <1 g/ml) (37.5%, 48/128) at pH 5.0 that was higher than that seen with moxifloxacin (2.3%, 3/128) (P < 0.001). The trends were similar regardless of which of the Asn-87, Asp-91, and A2143 point mutations were present. In conclusion, the superior antimicrobial efficacy of finafloxacin against H. pylori in an acidic environment suggests the possible use of finafloxacin for treatment of H. pylori infection, as has been proposed by its developer, Merlion Pharma. Helicobacter pylori infection is a cause of recurrent peptic ulcer disease, chronic gastritis, and gastric malignancies (1). It has been proven that the eradication of H. pylori can prevent peptic ulcer recurrence (2). However, drug instability and insufficient diffusion to gastric mucosa and mucus in that highly acidic environment require the combination of antibiotics with a proton pump inhibitor (PPI) for H. pylori eradication (3). PPI-clarithromycin-containing triple therapy was the first-line eradication treatment until recently (4). However, as the failure rate of the 7-day triple therapy has increased progressively, sequential or concomitant therapy has come to be used (3, 5). Unfortunately, the 7-day triple therapy is still regarded as the standard primary therapy in South Korea because there is no proven alternative regimen that can provide more efficient and safer eradication (6, 7). The unsatisfactory response of alternative eradication regimens was mainly caused by antimicrobial resistance and was particularly due to clarithromycin resistance (5, 8). Therefore, the Maastricht IV consensus has recommended that PPI-clarithromycin-containing triple therapy without prior susceptibility testing should be avoided when the clarithromycin resistance rate is higher than 15% to 20% (2). Moreover, the current high prevalence of metronidazole resistance in South Korea (9) indicates the necessity of reestablishment of a new standard first-line eradication therapy.In...

show abstract

Comparison of sequential and 7-, 10-, 14-d triple therapy forHelicobacter pyloriinfection

Abstract: There are no significant differences between 10-d sequential eradication therapy for H. pylori and any duration of standard triple treatment in Korean patients.

Cited by 59 publications

References 35 publications

Sequential Therapy for Helicobacter pylori Infection in Korea: Systematic Review and Meta-Analysis

Sequential Therapy for Helicobacter pylori Infection in Korea: Systematic Review and Meta-Analysis

The first-line regimens of Helicobacter pylori eradication in Korea

High Efficacy of Finafloxacin on Helicobacter pylori Isolates at pH 5.0 Compared with That of Other Fluoroquinolones

Contact Info

Product

Resources

About