Meta‐analysis: Four‐Drug, Three‐Antibiotic, Non‐bismuth‐Containing “Concomitant Therapy” Versus Triple Therapy for <i>Helicobacter pylori</i> Eradication

Essa, Abdallah; Kramer, Jennifer R.; Graham, David Y.; Treiber, Gerhard

doi:10.1111/j.1523-5378.2009.00671.x

Cited by 211 publications

(171 citation statements)

References 32 publications

(58 reference statements)

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“…Pooled estimates of the five RCTs showed superiority of non-bismuth-containing quadruple therapy over triple therapy with an OR of 2.86 (95 % CI 1.73-4.73) [36].…”

Section: Eradication Regimenmentioning

confidence: 98%

Evidence-based clinical practice guidelines for peptic ulcer disease 2015

et al. 2016

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The Japanese Society of Gastroenterology (JSGE) revised the evidence-based clinical practice guidelines for peptic ulcer disease in 2014 and has created an English version. The revised guidelines consist of seven items: bleeding gastric and duodenal ulcers, Helicobacter pylori (H. pylori) eradication therapy, non-eradication therapy, drug-induced ulcer, non-H. pylori, non-nonsteroidal anti-inflammatory drug (NSAID) ulcer, surgical treatment, and conservative therapy for perforation and stenosis. Ninety clinical questions (CQs) were developed, and a literature search was performed for the CQs using the Medline, Cochrane, and Igaku Chuo Zasshi databases between 1983 and June 2012. The guideline was developed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Therapy is initially provided for ulcer complications. Perforation or stenosis is treated with surgery or conservatively. Ulcer bleeding is first treated by endoscopic hemostasis. If it fails, surgery or interventional radiology is chosen. Second, medical therapy is provided. In cases of NSAID-related ulcers, use of NSAIDs is stopped, and anti-ulcer therapy is provided. If NSAID use must continue, the ulcer is treated with a proton pump inhibitor (PPI) or prostaglandin analog. In cases with no NSAID use, H. pylori-positive patients receive eradication and anti-ulcer therapy. If first-line eradication therapy fails, second-line therapy is given. In cases of non-H. pylori, non-NSAID ulcers or H. pyloripositive patients with no indication for eradication therapy, non-eradication therapy is provided. The first choice is PPI therapy, and the second choice is histamine 2-receptor antagonist therapy. After initial therapy, maintenance therapy is provided to prevent ulcer relapse.

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“…Pooled estimates of the five RCTs showed superiority of non-bismuth-containing quadruple therapy over triple therapy with an OR of 2.86 (95 % CI 1.73-4.73) [36].…”

Section: Eradication Regimenmentioning

confidence: 98%

Evidence-based clinical practice guidelines for peptic ulcer disease 2015

et al. 2016

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“…Another meta-analysis showed that concomitant therapy was superior to STT [99] . In studies published in South Korea, the eradication rate for concomitant therapy was considerably higher than that for sequential therapy [100,101] .…”

Section: Are There Suitable Sequential and Concomitant Therapy Alternmentioning

confidence: 99%

Antibiotic treatment forHelicobacter pylori: Is the end coming?

Kim

Choi

Chung

2015

WJGPT

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Infection with the Gram-negative pathogen Helicobacter pylori (H. pylori ) has been associated with gastroduodenal disease and the importance of H. pylori eradication is underscored by its designation as a group I carcinogen. The standard triple therapy consists of a proton pump inhibitor, amoxicillin and clarithromycin, although many other regimens are used, including quadruple, sequential and concomitant therapy regimens supplemented with metronidazole, clarithromycin and levofloxacin. Despite these efforts, current therapeutic regimens lack efficacy in eradication due to antibiotic resistance, drug compliance and antibiotic degradation by the acidic stomach environment. Core tip: This article reviews the recent literature describing antibiotic resistance and trends in Helicobacter pylori (H. pylori ) treatment. As there is no effective conventional therapy, new treatments are being developed and bismuth quadruple, sequential, concomitant therapies are recommended as a first-line regimen in regions with high levels of clarithromycin resistance. Quinolones have also been used for H. pylori treatment, although the cure rate has gradually reduced with this approach. New therapeutic directions include probiotic supplementation, tailored therapy, novel agents, and nanotechnology.

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“…The first quadruple non-bismuthcontaining regimen used these drugs concomitantly, typically twice a day. 9 Sequential therapy was a modification in which amoxicillin and a proton pump inhibitor were given for five days, followed by clarithromycin, a nitroimidazole and the proton pump inhibitor for five days (two drugs + three drugs). 10,11 In the presence of modest levels of clarithromycin resistance, these regi mens proved more successful than legacy triple therapy, generally providing between 90% and 94% eradication.…”

Section: Currently Recommended Regimensmentioning

confidence: 99%