Cure of <i>Helicobacter pylori</i> infection in elderly patients: comparison of low versus high doses of clarithromycin in combination with amoxicillin and pantoprazole

Franceschi, Marilisa; Leandro, Gioacchino; Bozzola, L.; Rassu, Mario; Soffiati, Giuliano; Mario, F. Di; Valerio, G.

doi:10.1046/j.1365-2036.2001.01008.x

Cited by 25 publications

(17 citation statements)

References 18 publications

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“…Such a low rate of side‐effects and high rate of compliance are probably due to the short (1 week) duration and the low dosage of both proton pump inhibitors and antibiotics used. Pertinent information has been taken from a recent study demonstrating that the reduction of the clarithromycin dose from 500 mg to 250 mg twice daily, in combination with amoxicillin, 1 g twice daily, and pantoprazole, 40 mg once daily, resulted in no significant differences in cure rates and tolerability in elderly subjects 67 . These results are in disagreement with data reported in non‐elderly populations, in which 500 mg b.d.…”

Section: Treatmentmentioning

confidence: 93%

An approach toHelicobacter pyloriinfection in the elderly

Pilotto

Malfertheiner

2002

Aliment Pharmacol Ther

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The prevalence of Helicobacter pylori infection increases with age world‐wide, reaching levels of 40–60% in asymptomatic elderly subjects and over 70% in elderly patients with gastroduodenal diseases. However, the percentage of H. pylori‐positive elderly patients who are treated for their infection remains very low. Data are now available that demonstrate the benefit of curing H. pylori infection in elderly patients with H. pylori‐associated peptic ulcer disease and severe chronic gastritis. Furthermore, the cure of H. pylori may prevent the progression of intestinal metaplasia and gastric atrophy. New studies are needed to clarify the role of eradication in elderly patients with non‐ulcer dyspepsia and gastro‐oesophageal reflux disease and in those who use non‐steroidal anti‐inflammatory drugs. H. pylori infection may be easily diagnosed by histological evaluation, rapid urease test or culture performed on gastric biopsies taken during endoscopy. However, the biopsy site must be carefully selected in elderly patients. For non‐invasive monitoring of H. pylori infection after treatment, the 13C‐urea breath test has significantly higher accuracy than serology in the elderly; further studies are needed to clarify the role of the H. pylori stool antigen test in old age. One‐week proton pump inhibitor‐based triple therapy regimens, including clarithromycin, amoxicillin and/or nitroimidazoles, are highly effective and well tolerated in elderly patients. Low doses of both proton pump inhibitors and clarithromycin (in combination with standard doses of amoxicillin or nitroimidazoles) are sufficient. Low compliance and antibiotic resistance are the main factors related to treatment failure in old age.

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Section: Treatmentmentioning

confidence: 93%

An approach toHelicobacter pyloriinfection in the elderly

Pilotto

Malfertheiner

2002

Aliment Pharmacol Ther

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“…Consequently, clarithromycin and fluoroquinolone doses should be reduced in patients with significant renal impairment to avoid the increased risk of adverse effects such as gastrointestinal upset and central nervous system effects, respectively . In a single‐center study of 154 patients older than 60 years with H. pylori infection, patients were randomized to receive clarithromycin triple therapy with either clarithromycin 250 mg twice/day or 500 mg twice/day . Numerically more patients receiving the higher clarithromycin dose reported having adverse events (9% vs 5%, p value not significant).…”

Section: Elderlymentioning

confidence: 99%

“…Unfortunately, to our knowledge, no studies have compared durations of therapy among elderly patients. Seven days of therapy were generally associated with low rates of treatment‐related adverse effects (4–7%), whereas studies evaluating 10–14 days of therapy reported variable rates (3–33%) . However, this potential advantage should be balanced with the risk of treatment failure.…”

Section: Elderlymentioning

confidence: 99%

Treatment of Helicobacter pylori in Special Patient Populations

et al. 2019

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Helicobacter pylori infection can lead to gastritis, gastric and duodenal ulcers, and gastric cancer. Consequently, complete eradication is the goal of therapy. First‐line therapy for H. pylori infection includes clarithromycin triple therapy (clarithromycin, proton pump inhibitor [PPI], and amoxicillin or metronidazole), bismuth quadruple therapy (bismuth salt, PPI, tetracycline, and metronidazole or amoxicillin), or concomitant therapy (clarithromycin, PPI, amoxicillin, and metronidazole). However, many patients have relative contraindications to the antibiotics included in these regimens, making therapy selection difficult. Furthermore, failure of initial therapy makes selection of second‐line therapy challenging due to concerns for potential resistance to agents included in the initial regimen. This review discusses H. pylori microbiology, including antibiotic resistance, and summarizes the existing evidence for first‐ and second‐line treatment regimens that may be considered for special populations such as patients with penicillin allergies, patients with or at risk for QTc‐interval prolongation, and patients who are pregnant, breastfeeding, or elderly.

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“…Concerning the dosage of antibiotics, a study demonstrated that a dose reduction of clarithromycin from 500 to 250 mg twice daily in combination with amoxycillin 1 g twice daily and pantoprazole 40 mg once daily did not change cure rates (ITT cure rates: 79% vs. 83%, respectively) and tolerability in elderly subjects (adverse events: 9% vs. 5%, respectively) [39]. These results are in disagreement with data reported in non‐elderly populations, in which 500 mg clarithromycin b.i.d.…”

Section: Treatmentmentioning

confidence: 99%

Helicobacter pylori infection in geriatrics

Pilotto

Salles

2002

Helicobacter

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The prevalence of Helicobacter pylori infection increases with age worldwide. However, the percentage of H. pylori-positive elderly patients who are tested and treated for their infection remains very low. We now have data that demonstrate the benefit of curing H. pylori infection in elderly patients with H. pylori-associated peptic ulcer disease and severe chronic gastritis. Furthermore, the cure of H. pylori may prevent progression of intestinal metaplasia and gastric atrophy. Studies are needed to clarify the role of eradication for elderly patients who have nonulcer dyspepsia, gastroesophageal reflux disease and who use nonsteroidal anti-inflammatory drugs. H. pylori infection may be easily diagnosed by histological evaluation, rapid urease test or culture performed on gastric biopsies taken during endoscopy. However, the biopsy site must be carefully selected in elderly patients. For noninvasive monitoring of H. pylori infection after treatment, the 13C-urea breath test has significantly higher accuracy than serology in the elderly. The role of the H. pylori stool antigen test in old age still needs to be clarified. One-week PPI-based triple therapy regimens including clarithromycin, amoxycillin and/or nitroimidazoles are highly effective and well tolerated in elderly patients. Low doses of both PPIs and clarithromycin (in combination with standard doses of amoxycillin or nitroimidazoles) are sufficient. Antibiotic resistance and low compliance are the main factors related to treatment failure at any age.

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Cure of Helicobacter pylori infection in elderly patients: comparison of low versus high doses of clarithromycin in combination with amoxicillin and pantoprazole

Cited by 25 publications

References 18 publications

An approach toHelicobacter pyloriinfection in the elderly

An approach toHelicobacter pyloriinfection in the elderly

Treatment of Helicobacter pylori in Special Patient Populations

Helicobacter pylori infection in geriatrics

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