High dose dual therapy versus bismuth quadruple therapy for Helicobacter pylori eradication treatment

Yang, Xue; Wang, Jinxia; Han, Shuang; Gao, Caiping

doi:10.1097/md.0000000000014396

Cited by 48 publications

(54 citation statements)

References 66 publications

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“…It should be borne in mind, however, that this applies to strains with low resistance levels (8-32 µg/mL), and higher resistance (>32 µg/mL) may reduce the effectiveness of this therapy from >90% to 60% [32]. Very promising results in the Asian population have been obtained for high-dose double therapy (AMX and PPIs), i.e., eradication rate >90% and low level of side effects (<15%) [33,34]. Avoiding the use of antibiotics with high frequency of resistance among H. pylori strains and the use of AMX, to which no resistance is currently observed in Poland, give hope for a wider use of this therapy.…”

Section: Discussionmentioning

confidence: 99%

High Primary Antibiotic Resistance of Helicobacter pylori Strains Isolated from Pediatric and Adult Patients in Poland during 2016–2018

et al. 2020

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Monitoring the antibiotic resistance of H. pylori is an important step in the effective treatment of this bacterium, thus the aim of the present study was to assess the prevalence of antimicrobial resistance of H. pylori strains isolated from pediatric and adult patients with primary infections in 2016–2018. Antral biopsies from 334 treatment-naïve patients (126 children and 208 adults) were obtained. A total of 71 clinical H. pylori strains (22 from children and 49 from adults) were isolated and examined for amoxicillin (AMX), clarithromycin (CLR), metronidazole (MTZ), tetracycline (TET), and levofloxacin (LEV) susceptibility. The activity of the antibiotics was measured by E-tests. Strains were considered as resistant to antibiotics with minimum inhibitory concentrations (MICs) equal to ≥0.125 μg/mL (AMX), ≥0.5 μg/mL (CLR), ≥8 μg/mL (MTZ), and ≥1 μg/mL (TET and LEV). The highest prevalence of antibiotic resistance in H. pylori strains was observed for CLR and MTZ, at frequencies of 54.5% and 31.8% vs. 30.6% and 46.9% for children and adults, respectively. A much lower frequency of isolation of resistant strains was demonstrated for LEV and TET, this being 9.1% and 4.5% vs. 18.4% and 4.1% for pediatric and adult patients, respectively. The presence of AMX-resistant strains was not observed. The H. pylori strains isolated from Polish patients with primary infections showed a high level of antibiotic resistance to CLR and MTZ (>30%).

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Section: Discussionmentioning

confidence: 99%

High Primary Antibiotic Resistance of Helicobacter pylori Strains Isolated from Pediatric and Adult Patients in Poland during 2016–2018

et al. 2020

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“…In another study from Taiwan, the HDDT achieved an eradication rate on ITT of 91.7% and was comparable to a non‐bismuth containing quadruple therapy 21 . A recent meta‐analysis of 4 studies showed a similar eradication rate between HDDT and bismuth quadruple therapy 22 …”

Section: Discussionmentioning

confidence: 93%

Searching for an optimal therapy for H pylori eradication: High‐dose proton‐pump inhibitor dual therapy with amoxicillin vs. standard triple therapy for 14 days

2020

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Background & Aims We compared a high‐dose dual therapy (HDDT) with rabeprazole and amoxicillin and compared it with a standard triple therapy (STT) with rabeprazole, amoxicillin, and clarithromycin for 2 weeks for H pylori eradication in treatment naïve patients. Methods H pylori‐positive patients were randomly assigned to either a rabeparzole (Pariet) 20 mg b.i.d., amoxicillin (Ospamox) 1 g b.i.d. and clarithromycin (Klacid) 500 mg b.i.d. for 14 days or rabeprazole (Pariet) 20 mg q.i.d., amoxicillin (Ospamox) 1 g q.i.d. also for 14 days. Eradication was tested for by the C13‐UBT at least 4 weeks after the completion of therapy. Results H pylori was eradicated in 86.2% of patients (81/94) (95% CI: 77.8‐91.7) in the STT group compared with 92.8% (90/97) (95% CI: 85.9‐96.5) in the HDDT group on ITT analysis. On PP analysis, H pylori was eradicated in 91.0% of patients (81/89) (95% CI: 83.3‐95.4) in the STT group compared with 93.8% (90/96) (95% CI: 87.0‐97.1) in the HDDT group. Side effects were few although many patients in the STT arm complained of bitter taste. The HDDT arm was well tolerated by patients. Conclusions The HDDT gave a high eradication rate comparable to the STT for 2 weeks and was a well‐tolerated regimen for H pylori eradication.

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“… 41 Another meta-analysis in 2016 proposed a DT regimen that involved taking amoxicillin ≥2 g/day and high-dose PPI 3–4 times daily. 42 In two recent meta-analyses, DT showed comparable eradication efficacy and fewer side effects when compared with BQT for 10–14 days 43 or guideline-suggested rescue therapies. 42 However, the inclusion criteria with respect to the definition of DT differed in these two meta-analyses, while most patients enrolled in the study by Yang et al received a first-line eradication regimen, and Gao et al included studies with H. pylori strain resistant to both metronidazole and clarithromycin, as well as patients who failed treatment more than two times.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of second-line regimens forHelicobacter pylorieradication treatment: a systemic review and network meta-analysis

Chang

Tung

et al. 2020

BMJ Open Gastroenterol

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BackgroundCurrent guidelines recommend bismuth-containing quadruple therapy (BQT) and quinolone-containing therapy after failure of first-line Helicobacter pylori eradication therapy. However, the optimum regimen of second-line eradication therapy remains elusive. We conducted a network meta-analysis to compare the relative efficacy of 16 second-line H. pylori eradication regimens.MethodsThree major bibliographic databases were reviewed to enrol relevant randomised controlled trials between January 2000 and September 2018. Network meta-analysis was conducted by STATA software and we performed subgroup analysis in countries with high clarithromycin resistance and high levofloxacin resistance, and in patients with documented failure of first-line triple therapy.ResultsFifty-four studies totalling 8752 participants who received 16 regimens were eligible for analysis. Compared with a 7-day BQT, use of probiotic add-on therapy during, before, and after second-line antibiotic regimens, quinolone-based sequential therapy for 10–14 days, quinolone-based bismuth quadruple therapy for 10–14 days, bismuth quadruple therapy for 10–14 days, and quinolone-based triple therapy for 10–14 days were significantly superior to the other regimens. Subgroup analysis of countries with high clarithromycin resistance and high levofloxacin resistance revealed that the ranking of second-line eradication regimens was distributed similarly in each group, as well as in patients with failure of first-line triple therapy.ConclusionWe conducted a detailed comparison of second-line H. pylori regimens according to different antibiotic resistance rates and the results suggest alternative treatment choices with potential benefits beyond those that could be achieved using salvage therapies recommended by guidelines.

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High dose dual therapy versus bismuth quadruple therapy for Helicobacter pylori eradication treatment

Abstract: Supplemental Digital Content is available in the text

Cited by 48 publications

References 66 publications

High Primary Antibiotic Resistance of Helicobacter pylori Strains Isolated from Pediatric and Adult Patients in Poland during 2016–2018

High Primary Antibiotic Resistance of Helicobacter pylori Strains Isolated from Pediatric and Adult Patients in Poland during 2016–2018

Searching for an optimal therapy for H pylori eradication: High‐dose proton‐pump inhibitor dual therapy with amoxicillin vs. standard triple therapy for 14 days

Efficacy of second-line regimens forHelicobacter pylorieradication treatment: a systemic review and network meta-analysis

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