High-dose dual therapy is effective as first-line treatment for Helicobacter pylori infection

Öztürk, Kayhan; Kurt, Ömer; Çelebi, Gürkan; Sarlak, Hakan; Karakaya, Muhammed Fatih; Demirci, Hakan; Kılınç, Ali Yaşar; Uygun, Ahmet

doi:10.5152/tjg.2020.18974

Cited by 14 publications

(14 citation statements)

References 26 publications

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“…Internet tools such as WeChat, as well as conducting regular follow-up of patients. Third, high-dose dual therapy could reduce unnecessary antibiotic use and the related disadvantages such as antibiotic resistance and ADR, and was expected to be a promising alternative regimen (Gao et al, 2020;Ozturk et al, 2020;Park et al, 2017). H. pylori enters replicative phase at an almost neutral pH 6−7, while at acid pH 3−6 it turns into its coccoid form which is resistant to antibiotics (Ierardi et al, 2019).…”

Section: Discussionmentioning

confidence: 99%

“…Guidelines of the Italian Society of Gastroenterology and Digestive Endoscopy suggested that PPI‐amoxicillin three times daily could act as rescue therapy if levofloxacin triple therapy failed (Romano et al, 2022). Nevertheless, in view of the low variety and potentially satisfactory eradication rate with high‐dose dual therapy that has been reported, it is worth conducting more dose ranging studies and prospective comparative trials to confirm its efficacy and safety in different countries, especially in antibiotic‐resistant regions (Malfertheiner et al, 2022; Ozturk et al, 2020).…”

Section: Treatment Strategies For H Pylori Infectionmentioning

confidence: 99%

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Treatment strategies and pharmacist‐led medication management for Helicobacter pylori infection

Wang

Chen

Pei

et al. 2022

Drug Development Research

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Half of the world's population is Helicobacter pylori carrier. Updated guidelines and consensus have been issued across regions with the main aim of reducing social transmission and increasing H. pylori eradication rate. Although alternative therapies including traditional Chinese medicine and probiotics have also been used to improve H. pylori eradication rate in clinical practice, current mainstream treatment is still dependent on triple and quadruple therapies that includes antibacterial agents (e.g., amoxicillin and furazolidone) and proton pump inhibitor. Researches also assessed the eradication rate of optimized high-dose dual therapy in treating H. pylori infection. With the increase of antibiotic resistance rate, the treatment strategies for H. pylori infection are constantly adjusted and improved. Besides, low medication compliance is another key influencing factor for H. pylori treatment failure. Emerging studies indicate that pharmacists' intervention and new pharmaceutical care methods can enhance patient medication compliance, reduce adverse drug reactions, and improve H. pylori eradication rate. The purpose of this review is to summarize the advances in treating H. pylori infection and highlight the necessity of developing novel strategies to cope with the increasing challenges and to achieve personalized medication. Also, this review attaches great importance to pharmacists in optimizing H. pylori treatment outcomes as a routine part of therapy.

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Section: Discussionmentioning

confidence: 99%

Section: Treatment Strategies For H Pylori Infectionmentioning

confidence: 99%

Treatment strategies and pharmacist‐led medication management for Helicobacter pylori infection

Wang

Chen

Pei

et al. 2022

Drug Development Research

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“… 69 Another HDDT with rabeprazole in Turkey also achieved a satisfactory eradication rate of 91.3% ( Table 2 ). 70 More large-scale clinical studies are needed to formally promote HDDT into first-line therapy, especially in different populations, and to determine the types of PPI that can be used, the drug dosages, and the optimal frequency of administration.…”

Section: Empirical Treatmentmentioning

confidence: 99%

The status and progress of first-line treatment against Helicobacter pylori infection: a review

Liu

Wang

Shi

et al. 2021

Therap Adv Gastroenterol

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Helicobacter pylori (HP) is a major causative agent of chronic gastritis and peptic ulcer. HP is also engaged in the development of gastric cancer and gastric mucosa-associated lymphoid tissue lymphoma. It is an important pathogenic factor in various other systemic diseases, such as vitamin B12 deficiency, iron deficiency, and idiopathic thrombocytopenia. The current consensus is that unless there is a special reason, eradication therapy should be implemented whenever HP infection is found, and it is ideally successful the first time. International guidelines recommend that under certain conditions, treatment should be personalized based on drug susceptibility testing. However, drug susceptibility testing is often not available because it is expensive, time-consuming, and difficult to obtain living tissue. Each region has separately formulated guidelines or consensuses on empirical therapy. Owing to an increasing drug resistance rate in various places, the eradication rate of proton pump inhibitor (PPI) triple therapy and sequential therapy has been affected. These regimens are rarely used; the PPI triple especially has been abandoned in most areas. Currently, radical treatment regimens for HP involve bismuth-containing quadruple therapy and concomitant therapy. However, quadruple therapy has its own limitations, such as complex drug administration. To improve the effectiveness, safety, and compliance, many clinical studies have proposed useful modified regimens, which mainly include the modified bismuth-containing quadruple regimen, high-dose dual therapy, and vonoprazan-containing regimens. Studies have shown that these emerging regimens have acceptable eradication rates and safety, and are expected to become first-line treatments in empirical therapy. However, the problem of decline in the eradication rate caused by drug resistance has not been fundamentally solved. This review not only summarizes the effectiveness of mainstream regimens in the first-line treatment of HP infection with the currently increasing antibiotic resistance rates, but also summarizes the effectiveness and safety of various emerging treatment regimens.

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“…with high rates of corpus gastritis) and typically has required high doses of PPIs as measured in omeprazole equivalents. Recent studies in Asia where CYP2C19 rapid metabolizers are uncommon, parietal masses are low, and corpus gastritis is common to have shown that high‐dose PPI–amoxicillin can produce cure rates around 90% 16–23 . The effectiveness of the regimen is sensitive to factors such as total dose of amoxicillin, the frequency of amoxicillin and antisecretory drug administration, the duration/24‐h intragastric pH is maintained ≥6, and the duration of therapy.…”

Section: Vonoprazan–amoxicillin Dual Therapymentioning

confidence: 99%

“…Recent studies in Asia where CYP2C19 rapid metabolizers are uncommon, parietal masses are low, and corpus gastritis is common to have shown that high-dose PPI-amoxicillin can produce cure rates around 90%. [16][17][18][19][20][21][22][23] The effectiveness of the regimen is sensitive to factors such as total dose of amoxicillin, the frequency of amoxicillin and antisecretory drug administration, the duration/24-h intragastric pH is maintained ≥6, and the duration of therapy. Trials with PPIs suggested that 3 g of amoxicillin per day, a high potency PPI b.i.d., and duration of 14 days have proved effective.…”

Section: Vonoprazan-amoxicillin Dual Therapymentioning

confidence: 99%

Vonoprazan‐containingHelicobacter pyloritriple therapies contribution to global antimicrobial resistance

Graham

Lü

Shiotani

2020

J of Gastro and Hepatol

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Amoxicillin and proton pump inhibitor dual Helicobacter pylori therapy has proved not to be reliably highly effective primarily because of traditional proton pump inhibitors' inability to maintain a high intragastric pH. Clarithromycin and proton pump inhibitor H. pylori dual therapy failed in part because clarithromycin resistance emerged during therapy causing treatment failures. The combination of amoxicillin, clarithromycin, and proton pump inhibitor was subsequently undermined by increasing clarithromycin resistance. Although vonoprazan appeared to restore the effectiveness of triple therapy, the improvement was almost entirely to improved effectiveness of amoxicillin dual therapy component and resulted in the majority (>85% currently in Japan) of those receiving vonoprazan–amoxicillin plus a second antibiotic (e.g. clarithromycin, metronidazole, fluoroquinolone, or rifabutin) receiving no benefit from the second antibiotic. The results in somewhere between 2800 and 5600 kg of unnecessary clarithromycin per one million H. pylori treatment courses per year in Japan. The only contribution of the second antibiotic is to increase global antimicrobial resistance. There are now sufficient data to prove that optimized vonoprazan–amoxicillin dual therapy can reliably achieve cure rates ≥95%. This manuscript discusses use of the principles of antimicrobial stewardship to develop potassium‐competitive acid blocker‐containing H. pylori therapies that will reliably achieve high H. pylori cure rates with minimal or no use of excess antibiotics. Such therapies are urgently needed so that use of vonoprazan triple therapies can be curtailed while also improving overall H. pylori cure rates.

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High-dose dual therapy is effective as first-line treatment for Helicobacter pylori infection

Abstract: Stem cells for pancreatitis 425 Gastric injury and bacterial overgrowth 433 The effect of visceral fat on SMA configuration 451 Antiplatelet agents in ulcerative colitis 459 Differentiation of BMSCs into intestinal ce 466 GERDOFF ® efficacy in patients with GERD

Cited by 14 publications

References 26 publications

Treatment strategies and pharmacist‐led medication management for Helicobacter pylori infection

Treatment strategies and pharmacist‐led medication management for Helicobacter pylori infection

The status and progress of first-line treatment against Helicobacter pylori infection: a review

Vonoprazan‐containingHelicobacter pyloritriple therapies contribution to global antimicrobial resistance

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