In vitro selection of resistant Helicobacter pylori

Haas, Curtis E.; Nix, David E.; Schentag, J J

doi:10.1128/aac.34.9.1637

Cited by 123 publications

(103 citation statements)

References 18 publications

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“…The use of multiple antibiotics with differing mechanisms of action reduces the chance that an individual bacterium will develop the multiple mutations necessary for developing resistance to the prescribed drugs. While M. tuberculosis and H. pylori infection have very different clinical manifestations, the organisms have similar rates of spontaneous mutation 61,62 as well as similar mechanisms of resistance to drugs which inhibit protein synthesis. 63,64 These facts, in conjunction with data from the present study, suggest that antimicrobial therapy for these infections should be approached similarly.…”

Section: Discussionmentioning

confidence: 99%

Short‐course therapy with amoxycillin–clarithromycin triple therapy for 10 days (ACT‐10) eradicates Helicobacter pylori and heals duodenal ulcer

Wurzer

Rodrigo

Stamler

et al. 1997

Aliment Pharmacol Ther

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Background: Whilst the role of Helicobacter pylori eradication in managing duodenal ulcers has been established, consensus regarding the ideal regimen has not been achieved. Methods: Patients with H. pylori‐positive active duodenal ulcer were randomly assigned to receive triple therapy with amoxycillin 1000 mg b.d. + clarithromycin 500 mg b.d. + omeprazole 20 mg daily for 10 days (ACT‐10) or dual therapy with clarithromycin 500 mg t.d.s. + omeprazole 40 mg daily for 14 days (Dual). No additional acid suppression was provided following eradication therapy. Endoscopy, with biopsy for culture and histology, as well as 13C‐urea breath testing (13C‐UBT) were performed pre‐treatment to assess H. pylori infection. H. pylori eradication was established at 4–6 weeks follow‐up with culture (2 antral, 1 corpus biopsies), histology (2 antral biopsies), and 13C‐UBT. Ulcer healing by endoscopy and change in clinical symptoms were also assessed at 4–6 weeks. Results: Two hundred and sixty‐seven (267) patients were randomized to ACT‐10 (n=137) or Dual therapy (n=130). By per‐protocol and intention‐to‐treat analyses, H. pylori eradication at 4–6 weeks follow‐up was 91% (115/127) and 88% (120/136), respectively, for ACT‐10 patients and 59% (68/115) and 55% (72/130), respectively, for Dual therapy patients (P<0.001 for both analyses). Ulcer healing was high in both treatment groups: ACT‐10, 93% (118/127) and 90% (122/136), respectively; and Dual therapy, 91% (104/114) and 85% (111/130), respectively. Pre‐treatment resistance to clarithromycin was low (4%, 8/214) as compared to metronidazole resistance which was over 40%. Emergence of resistance to clarithromycin was observed in 2% of patients receiving ACT‐10 and in 25% of those receiving Dual therapy. ACT‐10 and Dual therapy patients experienced similar rates of drug‐related adverse events (33% vs. 32%, respectively) and discontinuation from therapy due to an adverse event (1.5% vs. 5%, respectively). More than 90% of patients were compliant with each prescribed medication. Conclusion: In patients with active duodenal ulcer, a 10‐day course of amoxycillin–clarithromycin‐based triple therapy without additional acid suppression is highly effective in eradicating H. pylori and healing duodenal ulcer.

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Section: Discussionmentioning

confidence: 99%

Short‐course therapy with amoxycillin–clarithromycin triple therapy for 10 days (ACT‐10) eradicates Helicobacter pylori and heals duodenal ulcer

Wurzer

Rodrigo

Stamler

et al. 1997

Aliment Pharmacol Ther

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“…14,15 Furazolidone has attracted attention because of its high ef®cacy in eradicating H. pylori when combined with proton pump inhibitors or colloidal bismuth subcitrate, together with clarithromycin or amoxicillin. 16 Resistance of H. pylori to furazolidone has been shown to be unlikely to develop. Previous studies have shown that some furazolidone combination therapies achieve high cure rates of H. pylori, and we have proposed that furazolidone may replace metronidazole in areas in which resistance to metronidazole is high.…”

Section: Discussionmentioning

confidence: 99%

One‐week regimens containing ranitidine bismuth citrate, furazolidone and either amoxicillin or tetracycline effectively eradicate Helicobacter pylori: a multicentre, randomized, double‐blind study

Lü¹,

Zhang²,

Hu³

et al. 2001

Aliment Pharmacol Ther

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Background: The metronidazole resistance of Helicobacter pylori strains has increased rapidly. Aim: To evaluate the efficacy and safety of new 1‐week regimens containing ranitidine bismuth citrate, furazolidone and either amoxicillin or tetracycline. Methods: One hundred and twenty patients with H. pylori‐positive inactive duodenal ulcer or non‐ulcer dyspepsia diagnosed by endoscopy were recruited randomly to receive one of two regimens for 7 days: ranitidine bismuth citrate, 350 mg b.d., furazolidone, 100 mg b.d., and either amoxicillin, 1000 mg b.d. (n=60), or tetracycline, 500 mg b.d. (n=60). H. pylori infection was identified by rapid urease testing and histology. 13C‐Urea breath test was performed to evaluate the cure of H. pylori infection at least 4 weeks after completion of triple therapy. Results: The eradication rates of H. pylori by ranitidine bismuth citrate–furazolidone–amoxicillin and ranitidine bismuth citrate–furazolidone–tetracycline regimens were 82% and 85% (P > 0.05), respectively, by intention‐to‐treat analysis, and 85% and 91% (P > 0.05), respectively, by per protocol analysis. Adverse effects were mild in both ranitidine bismuth citrate–furazolidone–amoxicillin and ranitidine bismuth citrate–furazolidone–tetracycline groups. Conclusions: One‐week regimens containing ranitidine bismuth citrate, furazolidone and amoxicillin or tetracycline are well tolerated and effective for the eradication of H. pylori.

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“…This antibiotic has demonstrated a high antimicrobial activity against H pylori if given as a single drug [175] , and the majority of first-line furazolidone-based combination therapies revealed eradication rates above 80% [92] . Primary resistance to furazolidone is virtually absent [158,176,177] , and its potential to develop resistance is as low as for bismuth compounds or amoxicillin [178] . Moreover, this drug has no cross-resistance potential to metronidazole [176] .…”

Section: Furazolidone-based Rescue Regimensmentioning

confidence: 99%

“…Primary resistance to furazolidone is virtually absent [158,176,177] , and its potential to develop resistance is as low as for bismuth compounds or amoxicillin [178] . Moreover, this drug has no cross-resistance potential to metronidazole [176] . Triple therapy in which furazolidone is used instead of metronidazole achieves high eradication rates, even in populations with a high prevalence of nitroimidazole resistance [179][180][181][182] .…”

Section: Furazolidone-based Rescue Regimensmentioning

confidence: 99%

“Rescue” regimens after Helicobacter pylori treatment failure

Gisbert¹

2008

WJG

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Helicobacter pylori (H pylori ) infection is the main cause of gastritis, gastroduodenal ulcer disease, and gastric cancer. After more than 20 years of experience in H pylori treatment, in my opinion, the ideal regimen to treat this infection is still to be found. Currently, apart from having to know first-line eradication regimens well, we must also be prepared to face treatment failures. Therefore, in designing a treatment strategy we should not focus on the results of primary therapy alone, but also on the final (overall) eradication rate. The choice of a "rescue" treatment depends on which treatment is used initially. If a clarithromycinbased regimen was used initially, a subsequent metronidazole-based treatment (quadruple therapy) may be used afterwards, and then a levofloxacinbased combination would be a third "rescue" option. Alternatively, it has recently been suggested that levofloxacin-based rescue therapy constitutes an encouraging second-line strategy, representing an alternative to quadruple therapy in patients with previous PPI-clarithromycin-amoxicillin failure, with the advantage of efficacy, simplicity and safety. In this case, a quadruple regimen may be reserved as a third-line rescue option. Finally, rifabutin-based rescue therapy constitutes an encouraging empirical fourthline strategy after multiple previous eradication failures with key antibiotics such as amoxicillin, clarithromycin, metronidazole, tetracycline, and levofloxacin. Even after two consecutive failures, several studies have demonstrated that H pylori eradication can finally be achieved in almost all patients if several rescue therapies are consecutively given. Therefore, the attitude in H pylori eradication therapy failure, even after two or more unsuccessful attempts, should be to fight and not to surrender.

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In vitro selection of resistant Helicobacter pylori

Cited by 123 publications

References 18 publications

Short‐course therapy with amoxycillin–clarithromycin triple therapy for 10 days (ACT‐10) eradicates Helicobacter pylori and heals duodenal ulcer

Short‐course therapy with amoxycillin–clarithromycin triple therapy for 10 days (ACT‐10) eradicates Helicobacter pylori and heals duodenal ulcer

One‐week regimens containing ranitidine bismuth citrate, furazolidone and either amoxicillin or tetracycline effectively eradicate Helicobacter pylori: a multicentre, randomized, double‐blind study

“Rescue” regimens after Helicobacter pylori treatment failure

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