Dual therapy with high doses of rabeprazole and amoxicillin versus triple therapy with rabeprazole, amoxicillin, and metronidazole as a rescue regimen for Helicobacter pylori infection after the standard triple therapy

Shirai, Naohito; Sugimoto, Mitsushige; Kodaira, Chise; Nishino, Masafumi; Ikuma, Mutsuhiro; Kajimura, Masayoshi; Ohashi, Kyoichi; Ishizaki, Takashi; Hishida, Akira; Furuta, Takahisa

doi:10.1007/s00228-007-0302-8

Cited by 88 publications

(86 citation statements)

References 53 publications

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“…As for the second-line therapy after failure of the first-line therapy, eradication rates over 90% were achieved (fig. 3b), which is consistent with other reports [25,26,27,28,29,30]. …”

Section: Resultssupporting

confidence: 83%

“…However, a gradual decline in the eradication rate with this regimen (<80%) has been reported due to the spread of CAM resistance in Japan [22,23,24]; a second-line therapy using MNZ in place of CAM was approved in 2007. Excellent eradication rates achieving more than 90% success were reported with these regimens (table 2) [25,26,27,28,29,30]. A major reason for this high efficiency may be ascribed to the low MNZ resistance in Japan [23,24].…”

Section: Resultsmentioning

confidence: 94%

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Clinical Management of Helicobacter pylori - The Japanese Perspective

Sugano

Osawa

Satoh

2014

Dig Dis

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Background: After the approval of health insurance coverage of eradication therapy for Helicobacter pylori-positive peptic ulcer disease (PUD) in 2000, comprehensive coverage for H. pylori infection itself was implemented in 2013. Methods: We did a literature search using PubMed database on the management of H. pylori infection including indications, regimens, outcomes of current eradication therapies, trends of antibiotic resistance rates and proposed third-line rescue therapy in Japan. We also collected data on changes of eradication rates in our hospital by searching electronic medical records. Results: After implementation of insurance coverage of eradication therapy for PUD, dramatic reduction of the number patients with PUD as well as spending on ulcer drug was documented. According to the current regulation, proton pump inhibitor (PPI)-based triple therapy with 2 antibiotics, amoxicillin (AMPC) plus clarithromycin, for 7 days is approved as the first-line therapy. After failure of the first-line therapy, PPI plus AMPC and metronidazole is authorized as the second line, which maintains an excellent eradication rate of over 90% in Japan. When these two therapies fail, a sitafloxacin-based therapy seems to be most promising among many rescue regimens. Conclusion: Comprehensive public health insurance coverage of H. pylori infection will promote eradication in Japanese people infected with H. pylori, whose risk of developing gastric cancer has been shown to be high. It also provides us a unique opportunity to study whether the broader indications can accelerate the reduction of gastric cancer in Japan in the same way we witnessed the reduction of PUD.

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“…As for the second-line therapy after failure of the first-line therapy, eradication rates over 90% were achieved (fig. 3b), which is consistent with other reports [25,26,27,28,29,30]. …”

Section: Resultssupporting

confidence: 83%

Section: Resultsmentioning

confidence: 94%

Clinical Management of Helicobacter pylori - The Japanese Perspective

Sugano

Osawa

Satoh

2014

Dig Dis

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“…with standard dose amoxicillin (i.e., 500 mg q.i.d .) (207)(208)(209). Th e results were highly heterogeneous among these studies, with eradication rates of 0, 54, and 91%.…”

Section: Clarithromycin Triple Therapymentioning

confidence: 98%

ACG Clinical Guideline: Treatment of Helicobacter pylori Infection

Chey

Leontiadis

Howden

et al. 2017

American Journal of Gastroenterology

1,316

1,505

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Helicobacter pylori ( H. pylori ) infection is a common worldwide infection that is an important cause of peptic ulcer disease and gastric cancer. H. pylori may also have a role in uninvestigated and functional dyspepsia, ulcer risk in patients taking low-dose aspirin or starting therapy with a non-steroidal anti-infl ammatory medication, unexplained iron defi ciency anemia, and idiopathic thrombocytopenic purpura. While choosing a treatment regimen for H. pylori , patients should be asked about previous antibiotic exposure and this information should be incorporated into the decision-making process. For fi rst-line treatment, clarithromycin triple therapy should be confi ned to patients with no previous history of macrolide exposure who reside in areas where clarithromycin resistance amongst H. pylori isolates is known to be low. Most patients will be better served by fi rst-line treatment with bismuth quadruple therapy or concomitant therapy consisting of a PPI, clarithromycin, amoxicillin, and metronidazole. When fi rst-line therapy fails, a salvage regimen should avoid antibiotics that were previously used. If a patient received a fi rst-line treatment containing clarithromycin, bismuth quadruple therapy or levofl oxacin salvage regimens are the preferred treatment options. If a patient received fi rst-line bismuth quadruple therapy, clarithromycin or levofl oxacin-containing salvage regimens are the preferred treatment options. Details regarding the drugs, doses and durations of the recommended and suggested fi rst-line and salvage regimens can be found in the guideline. Asia and Central and South America ( 8,22 ). Th ere is, however, preliminary evidence that it may be falling in some previously high prevalence areas ( 22 ). People immigrating to North America from Asia and other parts of the world have a much higher prevalence of the infection than people born in North America ( 23 ). In one study, the seroprevalence among immigrants from East Asia was 70.1% ( 24 ). Hispanic immigrants to North America have higher rates of the infection than fi rst-or second-generation Hispanics who were born here ( 25 ). QUESTION 2: WHAT ARE THE INDICATIONS TO TEST FOR, AND TO TREAT, H. PYLORI INFECTION? RecommendationsSince all patients with a positive test of active infection with H. pylori should be off ered treatment, the critical issue is which patients should be tested for the infection (strong recommendation, quality of evidence: not applicable), All patients with active peptic ulcer disease (PUD), a past history of PUD (unless previous cure of H. pylori infection has been documented), low-grade gastric mucosa-associated lymphoid tissue (MALT) lymphoma, or a history of endoscopic resection of early gastric cancer (EGC) should be tested for H. pylori infection. Th ose who test positive should be off ered treatment for the infection (strong recommendation, quality of evidence: high for active or history of PUD, low for MALT lymphoma, low for history of endoscopic resection of EGC).In patients with uninvestigated d...

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“…For firstline therapies, a decreased eradication rate and an increased CAM resistance rate has become problematic (1,8). However, the rates of H. pylori strain resistance to the MNZ used in second-line therapy in Japan have been reported to The eradication rates associated with RAM therapy in Japan have been reported to be within the range of 88-100% (6,7,(11)(12)(13). The guidelines of the Japanese Society for Helicobacter Research state that, while administration periods vary from five to 10 days, the eradication rate achieved with second-line eradication therapy is 81-96% (1).…”

Section: Discussionmentioning

confidence: 99%

A Multicenter Prospective Observational Study of Triple Therapy with Rabeprazole, Amoxicillin and Metronidazole for Helicobacter pylori in Japan

et al. 2012

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Objective Triple therapy with rabeprazole (RPZ), amoxicillin (AMPC) and metronidazole (MNZ) (RPZ+ AMPC+MNZ therapy: RAM therapy) has been approved by the Japanese Ministry of Health, Labour and Welfare as a second-line therapy for Helicobacter pylori-positive gastric and duodenal ulcers in Japan. The present multicenter prospective observational study aimed to investigate the safety and efficacy of RAM therapy in clinical practice. Methods Patients with H. pylori-positive gastric or duodenal ulcers (including ulcer scars) in whom firstline therapy was unsuccessful were administered 10 mg of RPZ, 750 mg of AMPC and 250 mg of MNZ twice daily for seven days (total: 14 doses) based on an approved dose and regimen. Patient background factors, including complications, previous medical history, concomitant drugs, eradication results and adverse events were recorded by the investigator. Results The incidence of adverse drug reactions was 2.21% and the H. pylori eradication rate was 92.8%. Subgroup analyses performed to investigate the patient background factors affecting safety and efficacy revealed no factors that significantly affected the incidence of adverse drug reactions or the H. pylori eradication rate. Conclusion Amid reports of decreased eradication rates with clarithromycin-based first-line therapy, the >90% H. pylori eradication rate achieved in the present study demonstrates the clinical efficacy of RAM therapy in subjects in whom first-line therapy is unsuccessful.

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Dual therapy with high doses of rabeprazole and amoxicillin versus triple therapy with rabeprazole, amoxicillin, and metronidazole as a rescue regimen for Helicobacter pylori infection after the standard triple therapy

Abstract: RA as well as RAM therapy are safe and effective rescue regimens for H. pylori infection after eradication failure by the standard triple therapy.

Cited by 88 publications

References 53 publications

Clinical Management of <b><i>Helicobacter pylori</i></b> - The Japanese Perspective

Clinical Management of <b><i>Helicobacter pylori</i></b> - The Japanese Perspective

ACG Clinical Guideline: Treatment of Helicobacter pylori Infection

A Multicenter Prospective Observational Study of Triple Therapy with Rabeprazole, Amoxicillin and Metronidazole for <i>Helicobacter pylori</i> in Japan

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