Influence of age on the steady state disposition of drugs commonly used for the eradication of <i>Helicobacter pylori</i>

Ammon, Susanne; Treiber, Gerhard; Kees, Frieder; Klotz, Ulrich

doi:10.1046/j.1365-2036.2000.00756.x

Cited by 25 publications

(20 citation statements)

References 31 publications

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“…In the elderly, the pharmacokinetic parameters of amoxicillin are similar to those in younger healthy controls 15 . When taken as part of a multi‐drug anti‐ H. pylori therapy, modifications in serum antibiotic concentrations were due principally to an age‐dependent decline in renal function 3 . In contrast, elderly patients who had taken five doses of clarithromycin 500 mg at 12‐h intervals had almost double the plasma concentrations (AUC) of the antibiotic and its main metabolite, 14‐hydroxy‐clarithromycin, compared with young controls 16 .…”

Section: Discussionmentioning

confidence: 99%

“…Advancing age is a significant factor influencing the steady state disposition and serum concentration of clarithromycin. This effect is independent of renal function 3 . To date, no studies have compared the efficacy and tolerability of different dosages of clarithromycin in combination with a proton pump inhibitor and amoxicillin in elderly populations.…”

Section: Introductionmentioning

confidence: 99%

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Cure of Helicobacter pylori infection in elderly patients: comparison of low versus high doses of clarithromycin in combination with amoxicillin and pantoprazole

Franceschi

Leandro

Bozzola

et al. 2001

Aliment Pharmacol Ther

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INTRODUCTIONOne-week triple therapies that include a proton pump inhibitor plus clarithromycin and amoxicillin (or a nitroimidazole) are currently the ®rst line anti-H. pylori treatments. 1 The importance of clarithromycin dose in 1-week proton pump inhibitor-based triple therapies was the focus of a recent meta-analysis that included 82 studies (6123 patients in 110 treatment arms). 2 Results indicated that clarithromycin 500 mg twice daily (b.d.) was more effective than 250 mg b.d. (86.6 vs. 78.2% cure rate with intention-to-treat analysis) when it was in combination with amoxicillin and a proton pump

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Cure of Helicobacter pylori infection in elderly patients: comparison of low versus high doses of clarithromycin in combination with amoxicillin and pantoprazole

Franceschi

Leandro

Bozzola

et al. 2001

Aliment Pharmacol Ther

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“…(in combination with a standard dose of PPI and amoxycillin 1 g twice daily) were more effective than lower dosages [40]. This varying drug‐response in subjects of different ages may be due to the known direct effect of age on clarithromycin distribution, an effect that is independent of renal function, while aging per se has little influence on the pharmacokinetics of amoxycillin and metronidazole [41]. However, recent studies suggest that mechanisms other than age, i.e.…”

Section: Treatmentmentioning

confidence: 99%

Helicobacter pylori infection in geriatrics

Pilotto

Salles

2002

Helicobacter

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The prevalence of Helicobacter pylori infection increases with age worldwide. However, the percentage of H. pylori-positive elderly patients who are tested and treated for their infection remains very low. We now have data that demonstrate the benefit of curing H. pylori infection in elderly patients with H. pylori-associated peptic ulcer disease and severe chronic gastritis. Furthermore, the cure of H. pylori may prevent progression of intestinal metaplasia and gastric atrophy. Studies are needed to clarify the role of eradication for elderly patients who have nonulcer dyspepsia, gastroesophageal reflux disease and who use nonsteroidal anti-inflammatory drugs. H. pylori infection may be easily diagnosed by histological evaluation, rapid urease test or culture performed on gastric biopsies taken during endoscopy. However, the biopsy site must be carefully selected in elderly patients. For noninvasive monitoring of H. pylori infection after treatment, the 13C-urea breath test has significantly higher accuracy than serology in the elderly. The role of the H. pylori stool antigen test in old age still needs to be clarified. One-week PPI-based triple therapy regimens including clarithromycin, amoxycillin and/or nitroimidazoles are highly effective and well tolerated in elderly patients. Low doses of both PPIs and clarithromycin (in combination with standard doses of amoxycillin or nitroimidazoles) are sufficient. Antibiotic resistance and low compliance are the main factors related to treatment failure at any age.

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“…6 1 3 . 0 [148] Quinidine 0.8 4.0 2.6 [149] Ranitidin * 0.2 8.5 9.6 [150] Risperidone * 0.95 (0.1!) 9.2 8.2 [151] Rizatriptan * -2 9 .…”

Section: Dose Adjustment With Factor Q and Creatinine Clearancementioning

confidence: 99%

Pharmacokinetic dosage guidelines for elderly subjects

Turnheim

2005

Expert Opinion on Drug Metabolism & Toxicology

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Ageing is associated with a decline in drug elimination; hence, using the same doses as in younger adults may result in higher plasma drug concentrations and toxicity. Two approaches are available for dose correction to account for decreased drug elimination. One procedure is based on the extrarenal elimination fraction (Q(0)) and the age-dependent changes in creatinine clearance; the other uses the decline in total drug clearance (CL). Mean values of Q(0) and CL in young and old people are reported for many drugs in the literature and are summarised in this article. Although the pharmacokinetic techniques for dose adjustment in the elderly are useful, they provide only an average dose correction and neglect age-dependent changes in drug bio-availability, plasma protein binding, the fate of active metabolites, and altered sensitivity to drugs. To account for pharmacodynamic changes in old age, clinical and/or biochemical targets should be defined as therapeutic goals. Drugs whose effects cannot be monitored in these terms should be avoided in elderly individuals.

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Influence of age on the steady state disposition of drugs commonly used for the eradication of Helicobacter pylori

Cited by 25 publications

References 31 publications

Cure of Helicobacter pylori infection in elderly patients: comparison of low versus high doses of clarithromycin in combination with amoxicillin and pantoprazole

Cure of Helicobacter pylori infection in elderly patients: comparison of low versus high doses of clarithromycin in combination with amoxicillin and pantoprazole

Helicobacter pylori infection in geriatrics

Pharmacokinetic dosage guidelines for elderly subjects

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