High eradication rate of Helicobacter pylori using a four-drug regimen in patients previously treated unsuccessfully

Tzivras, Michalis; Balatsos, V.; Souyioultzis, Stavros; Tsirantonaki, M; Skandalis, N.; Archimandritis, Athanasios

doi:10.1016/s0149-2918(97)80044-6

Cited by 6 publications

(4 citation statements)

References 11 publications

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“…Sequentially administered drugs were attempted in some early regimes (e.g., Logan et al in 1994 92 ), however the first true sequential therapy was a bismuth-containing regimen used to treat patient who had failed therapy with then standard bismuth, metronidazole, tetracycline triple therapy (n=31) or dual PPI plus amoxicillin therapy (n =88) 93 . The study was done in Greece which has a high background rate of metronidazole resistance and was typically an outlier in terms of cure rates from BMT triple therapy 32 .…”

Section: Bismuth Sequential Therapiesmentioning

confidence: 99%

How to Effectively Use Bismuth Quadruple Therapy

Graham

Lee

2015

Gastroenterology Clinics of North America

134

174

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Bismuth triple therapy was the first truly effective Helicobacter pylori eradication therapy. The addition of a proton pump inhibitor largely overcame the problem of metronidazole resistance. Resistance to its being the primary first line therapy have centered on convenience (the large number of tablets required) and side effects causing difficulties with patient adherence. Understanding why the regimen is less successful in some regions remains unexplained in part because of the lack of studies including susceptibility testing. A number of modifications have been proposed such as twice-a-day therapy which addresses both major criticism but the studies with susceptibility testing required to prove its effectiveness in high metronidazole resistance areas are lacking. Most publications lack the data required to understand why they were successful or failed (e.g., detailed resistance and adherence data) and are therefore of little value. We discuss and provide recommendations regarding variations including substitution of doxycycline, amoxicillin, and twice a day therapy. We describe what is known and unknown and provide suggestions regarding what is needed to rationally and effectively use bismuth quadruple therapy. Its primary use is when penicillin cannot be used or when clarithromycin and metronidazole resistance is common. Durations of therapy less than 14 days are not recommended.

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Section: Bismuth Sequential Therapiesmentioning

confidence: 99%

How to Effectively Use Bismuth Quadruple Therapy

Graham

Lee

2015

Gastroenterology Clinics of North America

134

174

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“…Various second‐line and `rescue' therapies are currently being investigated (Table 2). 49–55 Results of a recently published meta‐analysis on second‐line eradication regimens favour use of quadruple and ranitidine‐bismuth‐based triple therapies achieving eradication rates of 76 and 80%, respectively (Figure 2). 56 Eradication rates with proton pump inhibitor‐based dual therapy regimens were up to only 47% ( n =530).…”

Section: Second‐line Treatment Regimensmentioning

confidence: 99%

Treatment of Helicobacter pylori infection and factors influencing eradication

Qasim

O’Moráin

2002

Aliment Pharmacol Ther

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Currently available Helicobacter pylori eradication therapies are considered very effective and safe. The most recent eradication guidelines proposed in the Maastricht 2‐2000 Consensus Report recommend the use of proton pump inhibitors (standard b.d.) along with clarithromycin (500 mg b.d.) and amoxycillin (1000 mg b.d.) or metronidazole (500 mg b.d.) for a minimum of 7 days. The combination of amoxycillin and clarithromycin is preferred because it may favour best results with a second‐line proton pump inhibitor quadruple therapy. The recommended second‐line therapy includes a combination of a proton pump inhibitor (standard b.d.) with bismuth salt (subsalicylate/subcitrate 120 mg q.d.s.), metronidazole (500 mg t.d.s.), and tetracycline (500 mg q.d.s.) for a minimum of 7 days. Extended proton pump inhibitor‐based triple therapy can be used if bismuth is not available. Specialists should manage subsequent failures. Based on direct and indirect evidence from well‐designed studies and clinical experience, eradication is recommended in gastric and duodenal ulcers, MALToma, atrophic gastritis, postgastric cancer resection, and in first‐degree relatives of gastric cancer patients. The most common reason for treatment failure is poor compliance with eradication guidelines. Antibiotic resistance may be a significant factor in certain geographical areas. Proton pump inhibitors are an integral part of the eradication regimens as proved by meta‐analyses of clinical trials. Novel agents used in secondary failure are few and depend on the use of new antibiotics. The role of H. pylori‐specific antibiotics, probiotics, and vaccines is not established as yet. Widespread acceptance of the eradication guidelines should be regarded as the single most important factor in eradication success.

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“…Over the past few years, a number of other quadruple combinations have been evaluated (Table 2) [92][93][94][95][96][97]. Moreover, when the recommended first-line therapy fails, these quadruple regimens can be used as a rescue therapy (Table 3) [107][108][109][110][111][112][113][114][115][116][117]. Indeed, the most tested therapeutic strategy is the combination of the first-line triple and second-line quadruple therapy after failure.…”

Section: Alternative or Rescue Regimensmentioning

confidence: 99%

“…Furazolidone-omeprazole-amoxycillin 7 52 26/50 [98] Ranitidine bismuth citrate-tetracycline-tinidazole 14 90 46/51 [99] Ranitidine bismuth citrate-tetracycline-tinidazole 14 82 31/38 [100] Ranitidine bismuth citrate-amoxycillin-tinidazole 14 81 25/31 [101] Ranitidine bismuth citrate-metronidazole-tetracycline 7 83 25/30 [102] Rifabutin-pansoprazole-amoxycillin 10 67 30/45 [103] Rifabutin-omeprazole-amoxycillin 10 70 7/10 [104] Rifabutin-lansoprazole-amoxycillin 7 72 18/25 [105] Rifabutin-pansoprazole-amoxycillin 10 87 39/45 [103] Rifabutin-pansoprazole-amoxycillin 7 71 29/41 [106] Omeprazole-bismuth salt-metronidazole-tetracycline 14 77 60/78 [107] Omeprazole-bismuth salt-metronidazole-tetracycline 14 92 24/26 [108] Omeprazole-bismuth salt-metronidazole-tetracycline 7 68 27/40 [109] Omeprazole-bismuth salt-metronidazole-tetracycline 7 57 17/30 [102] Omeprazole-bismuth salt-metronidazole-tetracycline 7 84 41/49 [110] Omeprazole-bismuth salt-metronidazole-tetracycline 7 68 15/22 [111] Omeprazole-bismuth salt-metronidazole-amoxycillin 10 91 113/124 [112] Pansoprazole-bismuth salt-metronidazole-tetracycline 10 67 30/45 [103] Ranitidine-bismuth salt-metronidazole-tetracycline 14 76 59/78 [107] Lansoprazole-bismuth salt-metronidazole-tetracycline 7 95 20/21 [113] Lansoprazole-bismuth salt-metronidazole-tetracycline 7 86 56/65 [114] Rabeprazole-metronidazole-amoxycillin-clarithromycin 5 95 52/55 [115] Omeprazole-amoxycillin-clarithromycin-tinidazole 4 88 49/56 [116] Nitrofurantoin-omeprazole-metronidazole-tetracycline 14 70 21/30 [117] highly selective and potent anti-H. pylori activity and exhibited excellent efficacy in clearing H. pylori in experimentallyinfected Mongolian gerbils [134]. Whereas the clinical value of these agents needs to be confirmed, variable results have been reported with vaccination against H. pylori infection.…”

Section: % Intent-to-treat N Eradicated/n Recruitedmentioning

confidence: 99%

Alternative and rescue treatment regimens for Helicobacter pylori eradication

Xia

Wong

Talley

et al. 2002

Expert Opinion on Pharmacotherapy

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Eradication therapy has been incorporated into clinical practice. The regimens currently recommended for first-line treatment include a 2-week bismuth-based triple therapy (mainly in developing countries), a 1 - 2 week proton pump inhibitor (PPI)-based triple therapy and a 1-week ranitidine bismuth citrate (RBC)-based triple therapy. However, these regimens fail to eradicate Helicobacter pylori in up to 20% of patients due to poor compliance, inadequate treatment duration, smoking, old age and bacterial resistance to nitroimidazoles and/or macrolides in particular. Therefore, alternative regimens that avoid nitroimidazoles and/or macrolides or overcome bacterial resistance to these drugs, improve compliance, minimise side effects and/or reduce costs have been evaluated. One-week quadruple therapy, which adds a PPI or histamine receptor 2-blocker to bismuth-based triple therapy, usually achieves an eradication rate of 90% when used as an alternative first-line therapy but the efficacy decreases when used as a rescue therapy. Several new triple therapies that may be used as alternative and/or rescue therapies have been evaluated. Among these are furazolidone-based (furazolidone plus an antibiotic and a bismuth salt, a PPI or RBC), fluoroquinolone-based (levofloxacin or moxifloxacin plus an antibiotic and a PPI) and ecabet sodium-based (ecabet plus two antibiotics) triple therapies. Recently, rifabutin has been used in combination with a PPI and amoxycillin as a rescue therapy, with satisfactory eradication rates. In addition, a number of new antimicrobial agents are currently under investigation in in vitro studies but the clinical values of these agents needs to be confirmed.

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High eradication rate of Helicobacter pylori using a four-drug regimen in patients previously treated unsuccessfully

Cited by 6 publications

References 11 publications

How to Effectively Use Bismuth Quadruple Therapy

How to Effectively Use Bismuth Quadruple Therapy

Treatment of Helicobacter pylori infection and factors influencing eradication

Alternative and rescue treatment regimens for Helicobacter pylori eradication

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