Helicobacter Pylori First-Line and Rescue Treatments in the Presence of Penicillin Allergy

Gisbert, Javier P.; Barrio, Jesús; Modolell, Inés; Molina–Infante, Javier; Aísa, Ángeles Pérez; Castro‐Fernández, Manuel; Rodrigo, Luís; Cosme, Ángel; Gisbert, José Luis; Fernandez–Bermejo, Miguel; Marcos, Santiago; Marín, Alicia C; McNicholl, Adrián G.

doi:10.1007/s10620-014-3365-2

Cited by 44 publications

(71 citation statements)

References 34 publications

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“…In 64 penicillin-allergic patients with persistent H. pylori infection despite fi rst-line treatment with either bismuth quadruple or metronidazole-clarithromycin triple therapy, 10-day levofl oxacin-clarithromycin triple therapy led to a 64% eradication rate ( 191 ). Th is compares with a 37% success rate (9 out of 24 patients) if bismuth quadruple therapy was given aft er the metronidazole-clarithromycin-based triple therapy had failed in the same study.…”

Section: Levofl Oxacin Triple Regimen (Ppi Amoxicillin Levofl Oxacimentioning

confidence: 97%

ACG Clinical Guideline: Treatment of Helicobacter pylori Infection

Chey

Leontiadis

Howden

et al. 2017

American Journal of Gastroenterology

1,319

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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Section: Levofl Oxacin Triple Regimen (Ppi Amoxicillin Levofl Oxacimentioning

confidence: 97%

ACG Clinical Guideline: Treatment of Helicobacter pylori Infection

Chey

Leontiadis

Howden

et al. 2017

American Journal of Gastroenterology

1,319

1,505

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“…8 However, these eradication rates were lower than those in previous studies on first-line therapy with CLR-MTZ-PPIs, and the percentage of CAM-resistant strains in patients allergic to penicillin may be higher than that in the general population. 14 Our data showed that the eradication rate using a combination of CLR and MTZ with a PPI was only 54.6% (PP), which is not acceptable.…”

Section: Discussionmentioning

confidence: 78%

“…3 Penicillin allergy is the most common drug allergy and occurs in about 3%-7% of Japanese and 8% of Americans. [6][7][8] However, the Japanese government insurance does not cover STX, TC, and bismuth for H. pylori eradication, and increase in CLR-resistant H. pylori is problematic. Instead of regimens including AMX, a proton-pump inhibitor (PPI)-based triple therapy with metronidazole (MTZ) and clarithromycin (CLR) or sitafloxacin (STX) or tetracycline (TC) and a bismuth-containing quadruple therapy (PPI-bismuth-TC-MTZ) were recommended in previous reports.…”

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confidence: 99%

Vonoprazan improves the efficacy of Helicobacter pylori eradication therapy with a regimen consisting of clarithromycin and metronidazole in patients allergic to penicillin

et al. 2017

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“…Another study from Spain examined the optimal first‐line eradication regimen for patients with penicillin allergy and reported ITT eradication rates with omeprazole–clarithromycin–metronidazole of only 57% compared to 74% for PPI–bismuth–tetracycline–metronidazole, with equivalent rates of compliance and adverse events. In this specific group for second‐line treatment, ITT eradication rate with omeprazole–clarithromycin–levofloxacin was 64% after failure of either regimen .…”

Section: Triple Therapymentioning

confidence: 92%

Treatment of Helicobacter pylori Infection 2015

et al. 2015

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Many interesting articles have been published from many parts of the world over the last year assessing different issues around Helicobacter pylori eradication therapy. This article will address the published literature over the last year pertaining to the topic of treatment of H. pylori infection. The main themes that emerge are assessing the efficacy of standard triple therapy, as well as exploring new first-line treatments, mainly optimized nonbismuthand bismuth-containing quadruple therapies with some promising data also emerging on dual therapy. There was also considerable progress in investigating antibiotic resistance rates with much more data emerging from varied parts of the world compared to recent years. There have also been advances in the use of adjunctive therapies, especially probiotic therapies. Undoubtedly, the eradication of H. pylori remains a worthwhile goal to alleviate the burden of diseases caused by the complications of this infection, including dyspepsia, peptic ulcer disease, and gastric cancer. Triple TherapyA number of studies have been published this year, primarily from Asia, on standard triple therapy which remains the regimen recommended in the majority of published guidelines. A meta-analysis from China showed suboptimal eradication rates in this part of the world with a pooled rate of 74.5% which was inferior when compared to sequential therapy with relative risk (RR) = 0.863 [1]. Better, but still insufficient, eradication rates however were noted in Korea, with an overall eradication rate of 84% from 2005 to 2010 [2]. In Japan, while rates remain clearly suboptimal, eradication rates by per-protocol (PP) analysis have not changed between 2001 and 2010 although there has been a decline in eradication rates by intention-to-treat (ITT) analysis [3]. Another Japanese group from a region of higher clarithromycin resistance compared 7-day standard triple therapy with rabeprazole, amoxicillin, and clarithromycin (RAC) to rabeprazole, amoxicillin, and metronidazole (RAM). They found ITT eradication rates of 73% in the RAC group and 91% in the RAM group [4]. In other regions, a study in Nigeria found an eradication rate of 87% for triple therapy with no difference between 7 and 10 days of treatment [5]. An interesting study from Spain showed that when clarithromycin susceptibility testing is carried out prior to treatment, eradication rates reach 94% compared to 72% for empiric treatment, based on a 10-day regimen [6]. Similar findings emerged from a Japanese study where 97% eradication was achieved when antimicrobial susceptibility testing was carried out prior to treatment, and it was 95% eradication in a Korean study [7,8]. Another study from Spain examined the optimal first-line eradication regimen for patients with penicillin allergy and reported ITT eradication rates with omeprazole-clarithromycin-metronidazole of only 57% compared to 74% for PPI-bismuth-tetracyclinemetronidazole, with equivalent rates of compliance and adverse events. In this specific group for second-line treat...

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Helicobacter Pylori First-Line and Rescue Treatments in the Presence of Penicillin Allergy

Cited by 44 publications

References 34 publications

ACG Clinical Guideline: Treatment of Helicobacter pylori Infection

ACG Clinical Guideline: Treatment of Helicobacter pylori Infection

Vonoprazan improves the efficacy of Helicobacter pylori eradication therapy with a regimen consisting of clarithromycin and metronidazole in patients allergic to penicillin

Treatment of Helicobacter pylori Infection 2015

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