Efficacy of a multistep strategy for <i>Helicobacter pylori</i> eradication

Gasbarrini,; Ojetti,; Armuzzi,; Branca,; Canducci, Filippo; Torre, E Sanz; Candelli, Marcello; Pastorelli,; Fedeli,; Fadda,; Pola,

doi:10.1046/j.1365-2036.2000.00685.x

Cited by 72 publications

(66 citation statements)

References 18 publications

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“…Thus, as represented in Figure 2, it can be concluded that H. pylori eradication can finally be achieved in almost 100% of the patients if three 'rescue' therapies are consecutively given [Rokkas et al 2009;Gisbert et al 2008bGisbert et al , 2004Qasim et al 2005;Vicente et al 2002;Treiber et al 2002a;Beales, 2001;Zullo et al 2001a;Chan et al 2000;Seppala et al 2000;Gasbarrini et al 2000a;Gomollon et al 2000a].…”

Section: Authormentioning

confidence: 99%

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Review: Second-line rescue therapy of Helicobacter pylori infection

Gisbert

2009

Therap Adv Gastroenterol

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Helicobacter pylori infection is the main known cause of gastritis, gastroduodenal ulcer disease and gastric cancer. After more than 20 years of experience in H. pylori treatment, however, the ideal regimen to treat this infection has still to be found. Nowadays, apart from having to know well first-line eradication regimens, we must also be prepared to face treatment failures. Therefore, in designing a treatment strategy we should not focus on the results of primary therapy alone, but also on the final (overall) eradication rate. The choice of a 'rescue' treatment depends on which treatment is used initially. If a first-line clarithromycin-based regimen was used, a second-line metronidazole-based treatment (quadruple therapy) may be used afterwards, and then a levofloxacin-based combination would be a third-line 'rescue' option. Alternatively, it has recently been suggested that levofloxacin-based 'rescue' therapy constitutes an encouraging second-line strategy, representing an alternative to quadruple therapy in patients with previous PPI-clarithromycin-amoxicillin failure, with the advantage of efficacy, simplicity and safety. In this case, quadruple regimen may be reserved as a third-line 'rescue' option. Finally, rifabutin-based 'rescue' therapy constitutes an encouraging empirical fourth-line strategy after multiple previous eradication failures with key antibiotics such as amoxicillin, clarithromycin, metronidazole, tetracycline, and levofloxacin. Even after two consecutive failures, several studies have demonstrated that H. pylori eradication can finally be achieved in almost all patients if several 'rescue' therapies are consecutively given. Therefore, the attitude in H. pylori eradication therapy failure, even after two or more unsuccessful attempts, should be to fight and not to surrender.

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Section: Authormentioning

confidence: 99%

“…For example, in the study by Gasbarrini et al [2000a], a total of 2606 patients were administered a PPI, tinidazole and clarithromycin for 1 week. Patients with continuing infection were then given a second 1-week course of amoxicillin, clarithromycin and RBC.…”

Section: Authormentioning

confidence: 99%

Review: Second-line rescue therapy of Helicobacter pylori infection

Gisbert

2009

Therap Adv Gastroenterol

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“…Only four observational noncomparative studies including 283 patients reported the mean cure rates of SGT in third-line therapy [Cammarota et al 2004;Gasbarrini et al 2000;Liou et al 2013;Vicente et al 2002]. In addition, two noncontrolled studies [Fiorini et al 2013;Tay et al 2012] and one controlled nonrandomized study [Yahav et al 2006] reported cure rates of SGT mixing patients with second and third-line treatment.…”

Section: Studies Included Reporting Cure Rates Of Sgt In Third-line Tmentioning

confidence: 99%

Systematic review: third-line susceptibility-guided treatment for Helicobacter pylori infection

Puig

López-Góngora

Calvet

et al. 2016

Therap Adv Gastroenterol

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Background: Susceptibility-guided therapies (SGTs) have been proposed as preferable to empirical rescue treatments after two treatment failures. The aim of this study was to perform a systematic review and meta-analysis evaluating the effectiveness and efficacy of SGT as third-line therapy. Methods: A systematic search was performed in multiple databases. Studies reporting cure rates of Helicobacter pylori with SGT in third-line therapy were selected. A qualitative analysis describing the current evidence and a pooled mean analysis summarizing the cure rates of SGT in third-line therapy was performed. Results: No randomized controlled trials or comparative studies were found. Four observational studies reported cure rates with SGT in third-line treatment, and three studies which mixed patients with second-and third-line treatment also reported cure rates with SGT. The majority of the studies included the patients when culture had been already obtained, and so the effectiveness of SGT and empirical therapy has never been compared. A pooled mean analysis including four observational studies (283 patients) showed intention-to-treat and perprotocol eradication rates with SGT of 72% (95% confidence interval 56-87%; I 2 : 92%) and 80% (95% confidence interval 71-90%; I 2 : 80%), respectively. Conclusions: SGT may be an acceptable option as rescue treatment. However, cure rates are, at best, moderate and this approach has never been compared with a well-devised empirical therapy. The evidence in favor of SGT as rescue therapy is currently insufficient to recommend its use.

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“…Thus, as represented in Figure 2, it can be concluded that H pylori eradication can finally be achieved in almost 100% of the patients if three rescue therapies are consecutively given [72,76,140,141,[144][145][146]150,156,185,188] . Furthermore, these encouraging (cumulative) results have been obtained when more than three consecutive treatments have been prescribed [21] .…”

Section: Consecutive Eradication Treatmentsmentioning

confidence: 99%

“…For example, in the study by Gasbarrini et al [188] , a total of 2606 patients were administered a PPI, tinidazole and clarithromycin for 1 wk. Patients with continuing infection were then given a second 1-wk course of amoxicillin, clarithromycin and RBC.…”

Section: Consecutive Eradication Treatmentsmentioning

confidence: 99%

“Rescue” regimens after Helicobacter pylori treatment failure

Gisbert¹

2008

WJG

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Helicobacter pylori (H pylori ) infection is the main cause of gastritis, gastroduodenal ulcer disease, and gastric cancer. After more than 20 years of experience in H pylori treatment, in my opinion, the ideal regimen to treat this infection is still to be found. Currently, apart from having to know first-line eradication regimens well, we must also be prepared to face treatment failures. Therefore, in designing a treatment strategy we should not focus on the results of primary therapy alone, but also on the final (overall) eradication rate. The choice of a "rescue" treatment depends on which treatment is used initially. If a clarithromycinbased regimen was used initially, a subsequent metronidazole-based treatment (quadruple therapy) may be used afterwards, and then a levofloxacinbased combination would be a third "rescue" option. Alternatively, it has recently been suggested that levofloxacin-based rescue therapy constitutes an encouraging second-line strategy, representing an alternative to quadruple therapy in patients with previous PPI-clarithromycin-amoxicillin failure, with the advantage of efficacy, simplicity and safety. In this case, a quadruple regimen may be reserved as a third-line rescue option. Finally, rifabutin-based rescue therapy constitutes an encouraging empirical fourthline strategy after multiple previous eradication failures with key antibiotics such as amoxicillin, clarithromycin, metronidazole, tetracycline, and levofloxacin. Even after two consecutive failures, several studies have demonstrated that H pylori eradication can finally be achieved in almost all patients if several rescue therapies are consecutively given. Therefore, the attitude in H pylori eradication therapy failure, even after two or more unsuccessful attempts, should be to fight and not to surrender.

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Efficacy of a multistep strategy for Helicobacter pylori eradication

Cited by 72 publications

References 18 publications

Review: Second-line rescue therapy of Helicobacter pylori infection

Review: Second-line rescue therapy of Helicobacter pylori infection

Systematic review: third-line susceptibility-guided treatment for Helicobacter pylori infection

“Rescue” regimens after Helicobacter pylori treatment failure

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