New dual therapy for primary treatment of <i><scp>H</scp></i><i>elicobacter pylori</i> infection: A prospective randomized study in <scp>S</scp>hanghai, <scp>C</scp>hina

Liu, Ren; Lü, Hong; Li, Hai Yan; Zhu, Ling; Xu, Xiao Yu; Gu, Li; Ge, Zhi Zheng; Li, Xiao Bo

doi:10.1111/1751-2980.12186

Cited by 28 publications

(36 citation statements)

References 30 publications

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“…Furuta et al have long emphasised that in order to reliable achieve cure rates over 90%, it is important to administer amoxicillin approximately every 6 h and maintain the pH at 6 or above 80 110. Although several studies have suggested that dosing of amoxicillin such as every 8 h may also be effective,81 111 these studies have been done in Asia where atrophic gastritis and slow CYP2C19 metaboliser’s are common.…”

Section: Improving the Results With Bismuth By Increasing The Effect mentioning

confidence: 99%

Role of bismuth in improvingHelicobacter pylorieradication with triple therapy

Dore

Lü

Graham

2016

Gut

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225

248

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In most regions of the world, antimicrobial resistance has increased to the point where empirical standard triple therapy for Helicobacter pylorieradication is no longer recommended. The treatment outcome in a population is calculated as the sum of the treatment success in the subpopulation with susceptible infections plus treatment success in the subpopulation with resistant infections. The addition of bismuth (i.e., 14-day triple therapy plus bismuth) can improve cure rates despite a high prevalence of antimicrobial resistance. The major bismuth effect is to add an additional 30%-40% to the success with resistant infections. The overall result is therefore dependent on the prevalence of resistance and the treatment success in the subpopulation with resistant infections (eg, with proton-pump inhibitor-amoxicillin dual therapy). Here, we explore the contribution of each component and the mechanisms of how bismuth might enhance the effectiveness of triple therapy. We also discuss the limitations of this approach and provide suggestions how triple therapy plus bismuth might be further improved.

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Section: Improving the Results With Bismuth By Increasing The Effect mentioning

confidence: 99%

Role of bismuth in improvingHelicobacter pylorieradication with triple therapy

Dore

Lü

Graham

2016

Gut

Self Cite

225

248

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“…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%

“…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. It is well tolerated, and primary resistance among H. pylori is rare and was not found in this study.…”

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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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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“…A study in Japan, using 10 mg rabeprazole and 500 mg amoxicillin, 4 times a day for 2 weeks, reported a cure rate of 90.9% (95% CI: 81.2–96.6) in the ITT analysis and 93.8% (95% CI: 84.8–98.3) in the PP analysis [ 43 ]. In addition, a study in China reported that eradication was achieved in 89.8% (95% CI: 82.1–87.6) of 117 subjects in the ITT analysis and 93.0% (95% CI: 86.4–99.6) in the PP analysis, using 20 mg rabeprazole twice and 1 g amoxicillin 4 times a day, for 2 weeks [ 44 ]. In this study, the eradication rate was 79.3% (23/29) in the ITT analysis and 82.1% (23/28) in the PP analysis.…”

Section: Discussionmentioning

confidence: 99%

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

Kwack

Lim

et al. 2016

Gastroenterology Research and Practice

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Objective. The eradication rate of Helicobacter pylori (H. pylori) following standard triple therapy has declined over the past few decades. This study has determined whether high dose dual therapy (PPI and amoxicillin) is adequate for eradicating H. pylori in Korea. Methods. This was an open-labeled study of H. pylori infected treatment-naive patients. Subjects received dual therapy for 14 days: ilaprazole 40 mg tablets given twice a day and amoxicillin 750 mg tablets given 4 times a day. At the end of the therapy, the subjects visited the clinic to confirm compliance and monitor for any side effects. Subjects visited again after 4–6 weeks to confirm H. pylori status through a urea breath test. Results. The cure rate of H. pylori was 79.3% (23 of 29) (95% confidence interval: 61.6–90.2) in the intention-to-treat analysis and 82.1% (23 of 28) in the per-protocol analysis. Compliance rates were high (96.6%) and side effects were minimal and tolerable. Conclusion. A high dose of ilaprazole + amoxicillin was ineffective as the first-line therapy for eradicating H. pylori in Korea. Future studies should focus on intragastric pH measurements and assess amoxicillin resistance.

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New dual therapy for primary treatment of Helicobacter pylori infection: A prospective randomized study in Shanghai, China

Abstract: The modified dual therapy with high doses of rabeprazole and amoxicillin is considered an effective and safe primary therapy for H. pylori eradication and could be recommended as the first-line eradication regimen for certain patients.

Cited by 28 publications

References 30 publications

Role of bismuth in improvingHelicobacter pylorieradication with triple therapy

Role of bismuth in improvingHelicobacter pylorieradication with triple therapy

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

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

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