High‐dose dual therapy and CYP2C19 polymorphism in Helicobacter pylori eradication

Abstract

Helicobacter pylori infection is common worldwide. There are many treatment regimens regarding H pylori infection over decades.Due to increasing antibiotic resistance, higher treatment failure rate for H pylori is a growing global concern. The significant number of primary drug resistance to amoxicillin, clarithromycin and metronidazole were reported in America, Europe as well as in Asia. 1 The drug resistance was more common in ASEAN region. 1 Antimicrobial susceptibility testing has been suggested in areas of high antibiotic resistance after the failure of first-line treatment. 2,3 However, this test is not available in most centres particularly in resource limited countries. To solve this problem, treatment protocols with substantially high eradication rates and low antibiotic

Refractoriness to anti‐Helicobacter pylori treatment attributed to phenotypic resistance patterns in patients with gastroduodenopathy in Guayaquil‐Ecuador

“…52 On the other hand, another critical drug within the triple standard therapeutic schemes is AMX, a β-lactam; however, its efficacy is greatly diminished by poor gastric acid inhibition; therefore, correct dosing and frequency of PPIs together with three to four times daily AMX administrations would allow the antimicrobial action to be optimized in blood for 24 h coinciding with the correct pharmacodynamic dosing of β-lactams. [53][54][55] Several studies have corroborated the efficacy of treatments using high doses of AMX (850 mg or 1 g three times a day) combined with high doses of PPIs at a dose of 40 mg three times a day, achieving an efficacy of over 90% in patients with gastric MALT lymphoma or peptic ulcers. [48][49][50][51][52][53][54] Furthermore, research agrees that this therapy, used as a first-line treatment, achieves eradication rates of over 90%.…”

“…The rationale behind this strategy is to take full advantage of the cell wall disruption caused by amoxicillin to achieve optimal entry of subsequent drugs. [53][54][55] These treatment schemes could be considered as options for eradication therapies, especially in the face of increasing progressive antimicrobial resistance. These therapeutic approaches could also be proposed as first-line options for the timely eradication of H. pylori within the Ecuadorian state's public health policies.…”

“…54 Several prospective randomized controlled trials have demonstrated its efficacy compared to salvage therapies such as bismuth quadruple and rifabutin triple therapy. [48][49][50][51][52][53][54][55][56] There are also therapeutic approaches based on dual therapy, such as sequential therapy, which consists of dual therapy for five days, followed by triple therapy with CLA 500 mg + tinidazole 500 mg + PPI twice daily for an additional five days. The rationale behind this strategy is to take full advantage of the cell wall disruption caused by amoxicillin to achieve optimal entry of subsequent drugs.…”

Personalized Approach in Eradication of Helicobacter pylori Infection

“…CYP2C19 is the main enzyme in the metabolism of PPI [75]. Furthermore, the effects of PPI are determined by the activity of metabolic enzymes, cytochrome P450 enzymes and CYP2C19 with genetic differences (the homozygous EM (HomEM), heterozygous EM (HetEM) and poor metabolizer)) [76]. Thus, the genetic background of a patient and the pharmacological profile of drug can impact the decision whether we should use different PPIs and/or increase doses of PPIs.…”

GastroHep Asian Special Edition

“…[1][2][3] Also there is a study of CYP2C19 polymorphism and its effects on therapy. 4 Studies on non-invasive diagnosis of atrophic gastritis could lead to better detection of precancerous conditions and looking at the relationship between chronic dyspeptic symptoms and underlying precancerous gastric conditions are important studies to undertake. [5][6][7] Hepatology papers include one on mortality reporting from India.…”