Erradicación de Helicobacter pylori en pacientes con úlcera péptica tras fracaso de dos tratamientos previos: estudio prospectivo guiado por cultivo

Vicente, Raquel; Sicilia, Beatriz; Gallego, Sonia; Revillo, María José; Ducóns, Julio; Gomollón, Fernando

doi:10.1016/s0210-5705(02)70283-5

Cited by 28 publications

(3 citation statements)

References 24 publications

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“…There are several therapeutic regimens to eradicate H. pylori , involving bismuth, clarithromycin, amoxicillin, furazolidone, nitroimidazole compounds, quinolones, and proton pump inhibitors, in different combinations [ 1 – 6 ].…”

Section: Introductionmentioning

confidence: 99%

Standard Triple Therapy versus Sequential Therapy inHelicobacter pyloriEradication: A Double-Blind, Randomized, and Controlled Trial

Eisig

Navarro–Rodriguez

Teixeira

et al. 2015

Gastroenterology Research and Practice

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Aim. To compare 10-day standard triple therapy versus sequential therapy as first-line treatment in patients infected with H. pylori. Methods. One hundred H. pylori positive patients (diagnosed by rapid urease test and histology), with average age of 47.2, M/F = 28/72, were randomized to receive either standard triple treatment (TT) as follows: lansoprazole 30 mg, clarithromycin 500 mg, and amoxicillin 1 g, b.i.d. for ten days, or sequential treatment (ST) as follows: lansoprazole 30 mg, amoxicillin and placebo 1.0 g b.i.d for the first five days, followed by lansoprazole 30 mg, clarithromycin 500 mg, and tinidazole 500 mg b.i.d, for the remaining five days. Eradication rates were determined 60 days after treatment by urease, histology, or 13C-urea breath test. Results. In intention to treat (ITT) analysis, the rate of H. pylori eradication in the TT and ST groups was the same for both regimens as follows: 86% (43/50), 95% CI 93,3 to 73.4%. In Per protocol (PP) analysis, the rate of H. pylori eradication in the TT and ST groups was 87.8% (43/49), 95% CI 94,5 to 75.3% and 89.6% (43/48), 95% CI 95,8 to 77.3%, respectively. Conclusions. In Brazil, standard triple therapy is as equally effective as sequential therapy in eradicating Helicobacter pylori patients. This study was registered under Clinical Trials with number ISRCTN62400496.

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Section: Introductionmentioning

confidence: 99%

Standard Triple Therapy versus Sequential Therapy inHelicobacter pyloriEradication: A Double-Blind, Randomized, and Controlled Trial

Eisig

Navarro–Rodriguez

Teixeira

et al. 2015

Gastroenterology Research and Practice

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“…12,13 However, which rescue treatment is best is unclear as results from previous studies have been extremely heterogeneous. 14–22 Studies from Spain, USA, and Germany reported surprisingly low cure rates (< 70%) for those with multiple treatment failures even after rescue therapies applied with susceptibility testing. 14–19 Short duration, weak therapy, and lack of uniformity in selecting PPIs and antibiotics likely contributed to the low effectiveness.…”

Section: Discussionmentioning

confidence: 99%

Susceptibility-guided therapy for Helicobacter pylori infection treatment failures

Luo

Long

et al. 2019

Therap Adv Gastroenterol

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Background: Empirical therapy of Helicobacter pylori frequently results in treatment failure due to unrecognized antimicrobial resistance. The aim of this study was to investigate the effectiveness of susceptibility-guided therapy for rescue treatment of H. pylori infection in China. Methods: This was a prospective study of consecutive 200 patients infected with H. pylori with one or more treatment failures. The therapy chosen was susceptibility based using the most effective, best-tolerated regimens first and a locally proven, reliably effective regimen for multidrug-resistant infections. All patients received 14-day triple therapy, i.e. esomeprazole 20 mg and amoxicillin 1 g twice a day plus clarithromycin 500 mg twice a day, metronidazole 400 mg twice a day, or levofloxacin 500 mg daily, or, for multidrug-resistant infections, amoxicillin-containing bismuth quadruple therapy with esomeprazole 20 mg twice a day, bismuth 220 mg twice a day, amoxicillin 1 g three times a day, and metronidazole 400 mg four times a day. Antibiotic resistance was determined by agar dilution. Results: The eradication rate of susceptibility-guided therapy overall was 94.5% (189/200, 95% confidence interval: 90.4–97.2%). Around 28% (56/200) of patients carried strains susceptible to one of the tested antibiotics and were prescribed the triple therapy. A total of 144 multidrug-resistant patients received bismuth quadruple therapy. The eradication rates were all greater than 90%, i.e. 91.7% (11/12), 92.3% (12/13), and 93.5% (29/31) in those who received clarithromycin, metronidazole, and levofloxacin-containing triple therapy and 95.1% (137/144) for the bismuth quadruple therapy. There were no differences in eradication rates between the subgroups. Conclusions: Although susceptibility-guided therapy proved high efficacious despite the high proportion of multidrug-resistant strains, the strategy suggested the best approach for this population would be empirical amoxicillin-containing bismuth quadruple therapy. ClinicalTrials.gov identifier: NCT03413020.

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“…They tend to harbour strains resistant to major antibiotics such as clarithromycin and metronidazole. Although comparative studies are scarce, devising adequate empirical treatment [33] has obtained similar or better results than the currently recommended strategy of using culture-driven rescue therapies [34, 35]. As secondary resistances are frequent and major antibiotics cannot be used, treatment of these patients requires new antimicrobials and atypical antibiotic combinations, and represents a challenge for the clinician.…”

Section: H Pylori Treatment: Facing New Challenges and Scenariosmentioning

confidence: 99%

<i>Helicobacter pylori</i> Infection: Treatment Options

Calvet

2006

Digestion

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After two decades of progress the best current approach to treatment of Helicobacter pylori infection is a strategy that combines two consecutive complementary treatments. Current guidelines recommend a first-line triple therapy – 7–10 days of a proton-pump inhibitor (PPI), clarithromycin and amoxicillin – followed by a quadruple therapy combining a PPI, metronidazole, tetracycline and a bismuth salt for treatment failures. Regrettably, present cure rates for first-line triple therapy are below 80%, and many patients require second-line treatment with further testing and control visits. Although most compliant patients are cured by the second-line treatment, patients often do not complete the full process and, as a result, final cure rates for the whole strategy often fall below 90%. This means that more effective first-line therapies are required. Promising recent developments include using quadruple therapy as first-line therapy, the use of adjuvant lactoferrin with triple therapy and a newly devised combination of a PPI, clarithromycin, amoxicillin and metronidazole, known as sequential treatment. Additional future developments will re quire the incorporation of new antibiotic weapons in the anti-H. pylori arsenal. The new quinolones and rifamycin derivates have recently demonstrated their efficacy in the treatment of H. pylori infection.

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Erradicación de Helicobacter pylori en pacientes con úlcera péptica tras fracaso de dos tratamientos previos: estudio prospectivo guiado por cultivo

Cited by 28 publications

References 24 publications

Standard Triple Therapy versus Sequential Therapy inHelicobacter pyloriEradication: A Double-Blind, Randomized, and Controlled Trial

Standard Triple Therapy versus Sequential Therapy inHelicobacter pyloriEradication: A Double-Blind, Randomized, and Controlled Trial

Susceptibility-guided therapy for Helicobacter pylori infection treatment failures

<i>Helicobacter pylori</i> Infection: Treatment Options

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