High Dose Ilaprazole/Amoxicillin as First-Line Regimen for<i>Helicobacter pylori</i>Infection in Korea

Kwack, Wongun; Lim, Yun-Jeong; Lim, Chi-Yeon; Graham, David Y.

doi:10.1155/2016/1648047

Cited by 31 publications

(31 citation statements)

References 51 publications

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“…As with early studies, the results have been inconsistent and even regimens using the same therapies have not reliably achieved 90% or greater cure rates. Studies have been done in many countries including Korea, Japan, and the United States, and most report cure rates below 90% . Studies in China have also reported variable cure rates …”

Section: Discussionmentioning

confidence: 99%

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High‐dose PPI‐amoxicillin dual therapy with or without bismuth for first‐line Helicobacter pylori therapy: A randomized trial

Luo

Long

et al. 2019

Helicobacter

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Background A reliably highly effective high‐dose proton‐pump inhibitor plus amoxicillin (dual Helicobacter pylori therapy) has remained elusive. We compared whether the addition of bismuth to high‐dose dual therapy would improve the efficacy of high‐dose dual therapy as first‐line treatment. Methods This was an open‐label, randomized single‐center study of 160 treatment‐naive patients with H. pylori infection who were randomly assigned to 14‐day therapy with esomeprazole 40 mg twice a day plus amoxicillin 1 g three times a day with or without bismuth potassium citrate 600 mg (elemental bismuth 220 mg) twice a day. Antibiotic resistance was determined by agar dilution method and eradication by 13C‐urea breath test. Results The per‐protocol eradication rates were 96.1%; 95% CI = 88.9%‐99.2% (73/76) without bismuth vs 93.3%; 95% CI = 85.1%‐97.8% (70/75) with bismuth (P = 0.494). The intention‐to‐treat eradication rates were 92.5%; 95% CI = 84.4%‐97.2% (74/80) without bismuth and 88.8%; 95% CI = 79.7%‐94.7% (71/80) with bismuth (P = 0.416). Resistance to amoxicillin, clarithromycin, metronidazole, and levofloxacin was 0%, 31.7%, 81.4%, and 40.7%, respectively. Smoking reduced treatment effectiveness limited to those not receiving bismuth. The per‐protocol eradication rates were 70% (7/10) vs 100% (66/66) in smokers vs non‐smokers without bismuth (P = 0.002), and 100% (10/10) in smokers vs 92.3% (60/65) in non‐smokers with bismuth (P = 1.0). The adverse event rates were 7.5% (6/80) without bismuth vs 11.3% (9/80) with bismuth (P = 0.416). Conclusions Fourteen‐day high‐dose dual therapy was both effective and safe for first‐line treatment in a region of high prevalence antibiotic resistance. Adding bismuth only improved treatment effectiveness among smokers.

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Section: Discussionmentioning

confidence: 99%

“…Studies have been done in many countries including Korea, Japan, and the United States, and most report cure rates below 90%. 13,[18][19][20][21] Studies in China have also reported variable cure rates. 6,7,22 Amoxicillin, a β-lactam antibiotic, is currently widely used in the treatment of H. pylori infections.…”

Section: Discussionmentioning

confidence: 99%

High‐dose PPI‐amoxicillin dual therapy with or without bismuth for first‐line Helicobacter pylori therapy: A randomized trial

Luo

Long

et al. 2019

Helicobacter

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“…As a first-line option, a Korean group gave ilaprazole 40 mg tablets twice a day and amoxicillin 750 mg tablets 4 times a day for 14 days and reported a cure rate of 79.3%. 66 A meta-analysis of the use of dual therapy as a rescue therapy for H. pylori compared to a series of guidelinerecommended rescue therapies found rates of eradication (81.3% vs 81.5%) as well as compliance and adverse events to be comparable with recommended rescue treatments from international guidelines. 67…”

Section: Dual Therapymentioning

confidence: 99%

Treatment of Helicobacter pylori infection 2017

et al. 2017

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Over the last decade, it has been widely reported that the success of Helicobacter pylori eradication treatment is falling. A steady decline was observed in the number of patients achieving eradication with standard first-line triple therapy of two antibiotics and a proton pump inhibitor [1][2][3]. It now appears that the first-line eradication therapies most commonly used in everyday clinical practice fall considerably short of the 80% intention-to-treat (ITT) eradication rates that are considered the minimal acceptable levels as recommended in the Maastricht guidelines [4]. Interestingly, two studies emerged from Asian centers in the last 12 months, which show that, in this part of the world at least, eradication levels using standard therapies remain close to 80%. A Malaysian study showed a standard 1-week pantoprazole, amoxycillin, and clarithromycin regimen to be well tolerated and highly efficacious with a per-protocol eradication rate of 84% [5]. A Japanese study showed remarkably consistent per-protocol eradication rates from 2001 to 2009 fluctuating between 75 and 78% for standard 7-day triple-therapy regimens [6]. A limit of many studies especially those including clarithromycin or levofloxacin is that H. pylori susceptibility to the drugs, which is the main prediction of failure, was not tested. LevofloxacinThe use of levofloxacin as a first-line therapy has been examined in great depth in the last year. Levofloxacin may be used as a substitute for clarithromycin in either a standard triple or sequential regimen. A large study comparing the antibiotics in either regimen shows a clear advantage to levofloxacin in both combinations. Per-protocol cure rates for triple therapy were 66% for omeprazole-clarithromycin-amoxycillin compared with 83% for omeprazole-levofloxacin-amoxycillin and 81% for omeprazole-amoxycillin-clarithromycin-metronidazole vs 85% for omeprazole-amoxycillin-levofloxacinmetronidazole, with no difference in compliance rates or adverse events [7]. It has been proposed that sequential levofloxacin-based regimens are of most benefit in areas where clarithromycin resistance is in excess of 15%, and another study in such an area showed eradication rates of 81% with clarithromycin sequential therapy compared with 96% with levofloxacin sequential therapy. A third arm in this study looked at the dose of levofloxacin required and illustrated no benefit in increasing the dose from 250 to 500 mg [8]. Indeed, another study went so far as to suggest that once-daily dosing of a levofloxacin-based triple regimen may be as efficacious as twice daily [9]. The literature from Asia also seems to support levofloxacin as a good alternative first-line therapy. A study on a triple regimen showed per-protocol eradication rates of 78% for standard clarithromycin-containing therapies compared with 83% for a levofloxacin-based regimen [10]. Another study from the Middle East looked at whether combining clarithromycin and levofloxacin in the same regimen could be Keywords Peptic ulcer disease, resistance, compli...

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“…Kwack and co-workers (2016) reported the high doses of the PPI, liaprazole (80 mg per day) and AMX 3000 mg per day for 14 days as the first line therapy and the cure rate was 79.3%. A meta-analysis of dual therapy as a rescue therapy for H. pylori compared to other rescue therapies found eradication rates were almost same, 81.3% vs. 81.5% (Gao et al 2016).…”

Section: History Of H Pylori Therapiesmentioning

confidence: 99%

Current and Future Treatment of Helicobacter pylori Infections

Matsumoto

Shiotani

Graham

2019

Advances in Experimental Medicine and Biology

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Helicobacter pylori is one of the most common human pathogens and it has been estimated that about 50% of the world’s population is currently infected. The present consensus is that, unless there are compelling reasons, all H. pylori infections should be cured. Since the 1990s, different national and international guidelines for the management of H. pylori-related diseases have been published and periodically updated regarding indications for treatment, diagnostic procedures, and preferred treatment regimens. Most guidelines provide sophisticated meta-analyses examining the outcome of different regimens done in regions with variable, often high rates of resistance to antibiotics, for which the prevalence and effects of resistance was often ignored. Although successful antimicrobial therapy must be susceptibility-based, increasing antimicrobial resistance and general unavailability of susceptibility testing have required clinicians to generally rely on empiric regimens. Antibiotics resistance of H. pylori has reached alarming high levels worldwide, which has an effect to efficacy of treatment. The recommendations should provide regimes for multi-resistant infections or for those where susceptibility testing is unavailable or refused. The first rule is to use only proven locally effective therapies. Because of patient intolerances, drug allergies, and local experiences, the clinicians should have at least two options for first-line therapy. As with any antimicrobial therapy, a thorough review of prior antibiotic use is invaluable to identify the presence of probably resistance. The second key is patient education regarding potential and expected side-effects and the importance of completing the course of antibiotics. We also review here triple therapies, sequential-concomitant, hybrid therapies, bismuth therapies, dual therapy, vonoprazan, modern antibiotic treatments, probiotics and vaccination.

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High Dose Ilaprazole/Amoxicillin as First-Line Regimen forHelicobacter pyloriInfection in Korea

Cited by 31 publications

References 51 publications

High‐dose PPI‐amoxicillin dual therapy with or without bismuth for first‐line Helicobacter pylori therapy: A randomized trial

High‐dose PPI‐amoxicillin dual therapy with or without bismuth for first‐line Helicobacter pylori therapy: A randomized trial

Treatment of Helicobacter pylori infection 2017

Current and Future Treatment of Helicobacter pylori Infections

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