Concomitant, sequential, and hybrid therapy for H. pylori eradication: A pilot study

Zullo, Angelo; Scaccianoce, Giuseppe; Francesco, Vincenzo De; Ruggiero, Valentina; D’Ambrosio, Pasquale; Castorani, Luigi; Bonfrate, Leonilde; Vannella, Lucy; Hassan, Cesare; Portincasa, Piero

doi:10.1016/j.clinre.2013.04.003

Cited by 79 publications

(83 citation statements)

References 17 publications

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“…This finding confirms previous positive observations from our [9] and other groups [47,48]. Although the sequential therapy has been considered by the 2012 Maastricht/Florence Consensus [5] and by the recent Italian Guidelines [13], the current guidelines indicate that the presence of clarithromycin resistance undermines the efficacy of this therapeutic approach [1].…”

Section: Discussionsupporting

confidence: 80%

“…The so-called 10-day "concomitant" therapy (non-bismuth quadruple), although representing an option as first line therapy [10,52], has been used by our group in a previous trial [9] with eradication rates of 85.5% (ITT) and 91.6% (PP) but was not used in the present study.…”

Section: Discussionmentioning

confidence: 97%

“…This outcome was probably due to the presence of tinidazole-susceptible H. pylori strains [1,49,50]. Evidence suggests that the sequential therapy besides being highly effective (91.1% and 92.1% eradication rates at ITT and PP analysis) [9], can overcome the issue of clarithromycin resistance [47].…”

Section: Discussionmentioning

confidence: 99%

“…1.2. Sequential treatment [9,11]: PPI (pantoprazole 40 mg) + amoxicillin 1000 mg each administered twice daily for 5 days followed by PPI + clarithromycin 500mg + tinidazole 500 mg, each administered twice daily for the remaining 5 days. 2.…”

Section: First-line Regimensmentioning

confidence: 99%

“…Of note, clarithromycin resistance is J Gastrointestin Liver Dis, June 2017 Vol. 26 No 2: 129-137 rapidly increasing worldwide [6] and this trend undermines the efficacy of the standard first-line triple (proton pump inhibitor -PPI, amoxicillin, clarithromycin) therapy, yielding a low eradication rate (<80%) [7][8][9]. Other first-line regimens included the "sequential" (PPI, amoxicillin followed by clarithromicin and tinidazole) therapy [9][10][11].…”

Section: Introductionmentioning

confidence: 99%

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Eradication Rates in Italian Subjects Heterogeneously Managed for Helicobacter pylori Infection. Time to Abandon Empiric Treatments in Southern Europe

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Scaccianoce

Venerito

et al. 2017

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Background & Aims: H. pylori eradication is strongly affected by various factors, including the ongoing antibiotic resistance. We describe a “real life” scenario in patients managed for H. pylori-related conditions, living in a southern Italian region (Apulia), an area with clarithromycin resistance >15%.Methods: 2,224 subjects were studied in two tertiary referral centers in Apulia. Analyses included: reason for referral, H. pylori infection rates (13C-urea breath test – UBT or upper endoscopy), and eradication rates following distinct regimens previously prescribed or prospectively prescribed (such as the bismuth-based quadruple therapy Pylera®, recently marketed in Italy).Results. Over 80% of the patients were referred by family physicians (60% naïve subjects). The overall infection rate was 32.5% and it was similar in asymptomatic patients (31.1%) or with H. pylori-related symptoms/clinical conditions (34.3%). In the 987 H. pylori+ve patients receiving therapy, the overall eradication rate was 80.2% (ITT). Observed eradication rate varied greatly across different regimens: 57.1% (2nd line levofloxacin), 59.6% (unconventional), 70.7% (7-day triple), 73.2% (7-day undefined), 89% (10-day sequential) and 96.9% (ITT, 10 day Pylera®, 1st to 5th line regimens given to 227 patients).Conclusions. A heterogeneous “real life” scenario in Southern Europe shows that H. pylori+ve patients are put at risk of poor outcomes and points to the need of a susceptibility-based therapy according to guidelines and local microbial resistance. In the present setting (i.e. high clarithromycin resistance), despite the high observed eradication rate, sequential therapy should not be recommended (absent in guidelines, unneeded antibiotic). Bismuth-based quadruple treatment (1st, 2nd or subsequent lines) yields the highest eradication rates.Abbreviations: ALT: Altamura; BA: Bari; EGDS: esophagogastroduodenoscopy; GERD: gastro-esophageal reflux disease; H. pylori: Helicobacter pylori; ITT: intention-to-treat; PP: per-protocol; PPI: proton pump inhibitor; UBT: urea breath test.

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