Factors influencing the eradication of Helicobacter pylori with triple therapy

Graham, David Y.; Lew, Ginger M.; Malaty, Hoda M.; Evans, Dolores G.; Evans, Doyle J.; Klein, Peter; Alpert, Lesley; Genta, Robert M.

doi:10.1016/0016-5085(92)90095-g

Cited by 509 publications

(313 citation statements)

References 11 publications

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“…An important factor determining the successful outcome of treatment is compliance to medications. 8 The advantages of a short-course, lowdose therapy with respect to this are obvious, as can be seen with the high rate of compliance amongst our patients in this study. Low-dose therapeutic regimens are more tolerable and result in fewer side-effects.…”

Section: Discussionsupporting

confidence: 53%

Comparison of two 1‐week low‐dose omeprazole triple therapies— optimal treatment for Helicobacter pylori infection?

Goh

Parasakthi

Chuah

et al. 1997

Aliment Pharmacol Ther

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Objectives:To determine and compare the efficacy and tolerability of two 1‐week regimen comprising omeprazole, clarithromycin and amoxycillin or metronidazole in the eradication of Helicobacter pylori, and to determine the influence of bacterial resistance to metronidazole and clarithromycin on the outcome of treatment.Patients and methods:Patients with unequivocal evidence of H. pylori infection based on culture, histology and rapid urease test of both antrum and corpus biopsies were recruited for the study. The study was a randomized, investigator‐blind, comparative study. Patients received either omeprazole 20 mg o.m., clarithromycin 250 mg b.d. and amoxycillin 500 mg b.d. (OAC) or omeprazole 20 mg o.m., metronidazole 400 mg b.d. and clarithromycin 250 mg b.d. (OMC) for 1 week. Patients were assessed for successful eradication, which was defined as absence of bacteria in all tests (culture, histology and urease test on both antral and corpus biopsies), at least 4 weeks after completion of therapy.Results:Eighty‐two patients were recruited for the study. Eradication rates on intention‐to‐treat analysis were—OAC: 36/41 (87.8%, 95% CI: 73.8, 95.9); OMC: 33/41 (80.5%, 95% CI: 65.1, 91.2). On per protocol analysis were—OAC: 36/40 (90%, 95% CI: 76.3, 97.2); OMC: 32/38 (84.2%, 95% CI: 68.7, 94.0). All side‐effects encountered were mild and no patient discontinued treatment because of intolerance to medications. The most common side‐effects were altered taste (OAC 31.7%, OMC 53.7%) and lethargy (OAC 14.6%, OMC 19.5%). Pre‐treatment metronidazole resistance was encountered in 34/63 (54.0%) patients. No bacterial strains were found with primary resistance to clarithromycin. Metronidazole resistance did not significantly affect eradication rates. Emergence of resistance to clarithromycin was not seen post‐therapy.Conclusions:Both the OAC and the OMC regimens were convenient and well‐tolerated treatments for H. pylori. However, eradication rates were lower than anticipated.

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Section: Discussionsupporting

confidence: 53%

Comparison of two 1‐week low‐dose omeprazole triple therapies— optimal treatment for Helicobacter pylori infection?

Goh

Parasakthi

Chuah

et al. 1997

Aliment Pharmacol Ther

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“…3 Our relatively good results may have been in part related to the overall good compliance. 5,28 However, the upper level of the 95% con®dence limits in this study was only 80%, with marked differences between smokers and non-smokers. Because of the overall low success rate, we do not plan to compare this therapy to others.…”

Section: Discussioncontrasting

confidence: 67%

“…3 Current successful therapies have been developed empirically without systematic investigation of potentially important variables such as chemical formulation, dosage, frequency of administration, relation to meals, duration of therapy, degree of acid inhibition required, age, gender, smoking or other habits. 5,6 Patient compliance and the presence of SUMMARY Aim: Effective anti-Helicobacter pylori therapies with few side-effects are needed. We studied the effectiveness of a low-dose combination of metronidazole, amoxycillin and omeprazole for treatment of ulcer patients in Seoul, Korea.…”

Section: Introductionmentioning

confidence: 99%

Successful low‐dose amoxycillin, metronidazole and omeprazole combination therapy in a population with a high frequency of metronidazole‐resistant Helicobacter pylori

Breuer

Kim

Gürer

et al. 1997

Aliment Pharmacol Ther

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Aim: Effective anti‐Helicobacter pylori therapies with few side‐effects are needed. We studied the effectiveness of a low‐dose combination of metronidazole, amoxycillin and omeprazole for treatment of ulcer patients in Seoul, Korea. Methods: Patients with gastric or duodenal ulcer received metronidazole (125 mg b.d.), amoxycillin (500 mg b.d.) and omeprazole (20 mg at bedtime) for 2 weeks. Endoscopic examinations were performed before treatment and at least 6 weeks after completion of antimicrobial therapy. H. pylori status was confirmed by histological examination of two gastric biopsies using the Genta stain. Results: Seventy‐nine patients (64 men, 15 women, mean age 46 years) with peptic ulcer were enrolled. H. pylori infection was cured in 56 (71%, 95% CI: 60–81%). The cure rate in non‐smokers was significantly higher than in smokers (88% vs. 65%, P=0.035). Twelve pre‐treatment isolates were available and metronidazole resistance was noted in all; H. pylori infection was cured in 10. Thirty‐six patients cured of H. pylori have been followed for 1 year (mean of 361 days) and 2 cases became reinfected (5.5%, 95% CI: 1–18%). Conclusions: The low‐dose combination of metronidazole, amoxycillin and omeprazole was effective even in the face of metronidazole resistance. Recurrence of H. pylori infection is infrequent even in countries with a high prevalence of H. pylori infection.

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“…Outro motivo alegado foi a resistência-negligência ao cumprimento de regras ou normas estabelecidas. Esse é um comportamento não raro entre alguns pacientes e do conhecimento de qualquer profissional de saúde 25,26 , não sendo, portanto, surpreendente que ocorra com a prescrição de rotinas dietéticas. Por fim, quadros de ansiedade também foram apontados como motivo de ruptura da adesão.…”

Section: I S C U S S ã Ounclassified

Avaliação da eficácia e do grau de adesão ao uso prolongado de fibra dietética no tratamento da constipação intestinal funcional

Machado

Capelari

2010

Rev. Nutr.

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OBJETIVO: Avaliar o grau de adesão e a eficácia da fibra dietética no tratamento da constipação intestinal funcional. MÉTODOS: Estudo clínico longitudinal, envolvendo 59 indivíduos, 54 mulheres e 5 homens, idade média de 46 anos (variação: 18-74 anos), com diagnóstico de constipação intestinal funcional. Após regularização do hábito intestinal, com a introdução de fibra dietética, era recomendado aos pacientes manter a dieta com fibra e retornar quatro meses depois, a fim de ser verificada a continuidade da eficácia e o grau de adesão ao seu uso. Associação entre adesão e eficácia foi pesquisada pelo teste exato de Fisher. RESULTADOS: Nove pacientes abandonaram o estudo e 50 continuaram. Destes, 32 mantiveram hábito intestinal satisfatório e a constipação recorreu em 18. Naqueles com manutenção do hábito intestinal, dezesseis mantiveram a ingestão de fibra recomendada, quatro aumentaram, nove reduziram e três interromperam. Nos casos com recorrência do sintoma, a quantidade de fibra foi mantida em três, aumentada em um, diminuída em três e suspensa em onze. Foi encontrada associação estatisticamente significante entre adesão e eficácia (p=0,008). CONCLUSÃO: A eficácia da fibra dietética mostrou-se moderada, ocorrendo benefício em 64% dos casos. A perda de adesão foi grande, mais da metade dos indivíduos avaliados (52%). Tais resultados sugerem a necessidade de novas estratégias, visando garantir maior fidelidade à terapêutica com fibra e com isto melhorar seus resultados no tratamento da constipação intestinal.

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Factors influencing the eradication of Helicobacter pylori with triple therapy

Cited by 509 publications

References 11 publications

Comparison of two 1‐week low‐dose omeprazole triple therapies— optimal treatment for Helicobacter pylori infection?

Comparison of two 1‐week low‐dose omeprazole triple therapies— optimal treatment for Helicobacter pylori infection?

Successful low‐dose amoxycillin, metronidazole and omeprazole combination therapy in a population with a high frequency of metronidazole‐resistant Helicobacter pylori

Avaliação da eficácia e do grau de adesão ao uso prolongado de fibra dietética no tratamento da constipação intestinal funcional

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