Optimization strategies aimed to increase the efficacy of <i>H. pylori</i> eradication therapies

Gisbert, Javier P.; McNicholl, Adrián G.

doi:10.1111/hel.12392

Cited by 82 publications

(104 citation statements)

References 124 publications

(254 reference statements)

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“…This study shows that high‐dose metronidazole in a PPI, clarithromycin, and metronidazole combination was unable to achieve high cure rates, and we suggest that this therapy should not be used in areas where dual resistance is a problem. However, bismuth is one of the few antimicrobials to which resistance has not developed and provides an additive effect which has been reported to improve cure rates significantly . Although the percent of improvement was limited by the relative high cure rates, overall in this study, the addition of bismuth appeared to increase the cure rate by ~26% (PP) and 21.2% (ITT).…”

Section: Discussionmentioning

confidence: 57%

“…Although the percent of improvement was limited by the relative high cure rates, overall in this study, the addition of bismuth appeared to increase the cure rate by ~26% (PP) and 21.2% (ITT). Our previous study showed that bismuth improved the outcome with standard‐dose metronidazole suggesting that the effect may not always require high‐dose metronidazole . These results suggest that the addition of bismuth is a rational strategy for therapies where resistance has reduced the effectiveness of currently available therapies.…”

Section: Discussionmentioning

confidence: 87%

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Bismuth improves efficacy of proton‐pump inhibitor clarithromycin, metronidazole triple Helicobacter pylori therapy despite a high prevalence of antimicrobial resistance

Long

Chen

et al. 2018

Helicobacter

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Section: Discussionmentioning

confidence: 57%

Section: Discussionmentioning

confidence: 87%

Bismuth improves efficacy of proton‐pump inhibitor clarithromycin, metronidazole triple Helicobacter pylori therapy despite a high prevalence of antimicrobial resistance

Long

Chen

et al. 2018

Helicobacter

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“…This is copper‐fastened by a new systematic review of all optimisation strategies for H. pylori eradication that shows the most direct way to optimize a treatment is using higher doses of drugs unless it has been shown that lower doses are equally effective. This applies to the use of potent acid inhibition and/or higher antibiotic doses‐especially by increasing the number of daily intakes‐and lengthening treatments up to 14 days . Bismuth based therapies are performing very well across numerous regions and the more novel pairings of it either as part of a “single triple” capsule or with other antibiotics may well enable clinicians to overcome some of the issues around tetracycline supply that have hampered the widespread adoption of bismuth based therapy.…”

Section: Resultsmentioning

confidence: 99%

“…There have been many and varied number of studies pertaining to treatments up to 14 days. 112 Bismuth based therapies are performing very well across numerous regions and the more novel pairings of it either as part of a "single triple" capsule or with other antibiotics may well enable clinicians to overcome some of the issues around tetracycline supply that have hampered the widespread adoption of bismuth based therapy. Levofloxacin and rifabutin remain useful alternatives, especially in rescue therapy settings.…”

Section: Discussionmentioning

confidence: 99%

Treatment of Helicobacter pylori infection 2017

et al. 2017

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Over the last decade, it has been widely reported that the success of Helicobacter pylori eradication treatment is falling. A steady decline was observed in the number of patients achieving eradication with standard first-line triple therapy of two antibiotics and a proton pump inhibitor [1][2][3]. It now appears that the first-line eradication therapies most commonly used in everyday clinical practice fall considerably short of the 80% intention-to-treat (ITT) eradication rates that are considered the minimal acceptable levels as recommended in the Maastricht guidelines [4]. Interestingly, two studies emerged from Asian centers in the last 12 months, which show that, in this part of the world at least, eradication levels using standard therapies remain close to 80%. A Malaysian study showed a standard 1-week pantoprazole, amoxycillin, and clarithromycin regimen to be well tolerated and highly efficacious with a per-protocol eradication rate of 84% [5]. A Japanese study showed remarkably consistent per-protocol eradication rates from 2001 to 2009 fluctuating between 75 and 78% for standard 7-day triple-therapy regimens [6]. A limit of many studies especially those including clarithromycin or levofloxacin is that H. pylori susceptibility to the drugs, which is the main prediction of failure, was not tested. LevofloxacinThe use of levofloxacin as a first-line therapy has been examined in great depth in the last year. Levofloxacin may be used as a substitute for clarithromycin in either a standard triple or sequential regimen. A large study comparing the antibiotics in either regimen shows a clear advantage to levofloxacin in both combinations. Per-protocol cure rates for triple therapy were 66% for omeprazole-clarithromycin-amoxycillin compared with 83% for omeprazole-levofloxacin-amoxycillin and 81% for omeprazole-amoxycillin-clarithromycin-metronidazole vs 85% for omeprazole-amoxycillin-levofloxacinmetronidazole, with no difference in compliance rates or adverse events [7]. It has been proposed that sequential levofloxacin-based regimens are of most benefit in areas where clarithromycin resistance is in excess of 15%, and another study in such an area showed eradication rates of 81% with clarithromycin sequential therapy compared with 96% with levofloxacin sequential therapy. A third arm in this study looked at the dose of levofloxacin required and illustrated no benefit in increasing the dose from 250 to 500 mg [8]. Indeed, another study went so far as to suggest that once-daily dosing of a levofloxacin-based triple regimen may be as efficacious as twice daily [9]. The literature from Asia also seems to support levofloxacin as a good alternative first-line therapy. A study on a triple regimen showed per-protocol eradication rates of 78% for standard clarithromycin-containing therapies compared with 83% for a levofloxacin-based regimen [10]. Another study from the Middle East looked at whether combining clarithromycin and levofloxacin in the same regimen could be Keywords Peptic ulcer disease, resistance, compli...

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“…When reviewing recent publications, as well as the “golden rules of therapy optimisation in H. pylori ”, it is easy to conclude that there is room for improvement in the regimens used at our centre: (a) an ITT effectiveness of 90% was achieved in a study using RIF 150 mg q.d. combined with AMO ≥1 g t.i.d and pantoprazole 80 mg t.i.d.…”

Section: Discussionmentioning

confidence: 99%

Empirical Helicobacter pylori rescue therapy: an 18‐year single‐centre study of 1200 patients

2019

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Background: Manychangeshavebeenmadetotheguidelinesonrescuetreatmentsfor Helicobacter pylori infection due to their poor effectiveness in clinical practice.Objective: To evaluate the use and effectiveness of different empirical rescue therapies for H. pylori infection in a specialised consultation unit over 18 years. Methods:Design: analysis of a systematic, prospective, single-centre data record.Patients: consecutive patients in whom at least one H. pylori eradication regimen had failed. Intervention: consecutive rescue therapies were prescribed empirically according to the best scientific evidence. Helicobacter pylori eradication was defined by a negative 13 C-ureabreathtest.Results: A total of 1200 subjects were included. Eleven different therapies were used during the study period, being the seven most common: proton pump inhibitor (PPI)-levofloxacin (LEV)-amoxicillin (AMO); PPI-bismuth(BIS)-LEV-AMO; PPI-moxifloxacin-AMO; ranitidine bismuth citrate-tetracycline-metronidazole; classical BIS (BIS)-containing quadruple therapy; PPI-Pylera ® and PPI-rifabutin (RIF)-AMO. The effectivenessofthesecond-,third-,fourth-andfifth-linerescuetherapieswas77%, 71%,60%and58%,respectively.Thecumulativeeffectivenessafterfiveconsecutive therapieswas99.8%.Thethreemosteffectivesecond-andthird-linetherapieswere: PPI-Pylera ® (96%and82%,respectively),classicalBIS-containingquadrupletherapy (92%and89%)andPPI-BIS-LEV-AMO(88%and84%). Conclusions: Helicobacter pylori eradication can be achieved virtually in all cases by the administration of several consecutive empirical therapies. The most effective second-linestrategyistheadministrationofaBIS-containingquadrupletherapy(either classical, Pylera ® or with LEV-AMO). The most effective third-line strategy is theadministrationofanotpreviouslyusedBIS-containingquadrupletherapy.Agood alternativeasafourth-linetherapyistheadministrationofPPI-RIF-AMO-BIS.

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Optimization strategies aimed to increase the efficacy of H. pylori eradication therapies

Cited by 82 publications

References 124 publications

Bismuth improves efficacy of proton‐pump inhibitor clarithromycin, metronidazole triple Helicobacter pylori therapy despite a high prevalence of antimicrobial resistance

Bismuth improves efficacy of proton‐pump inhibitor clarithromycin, metronidazole triple Helicobacter pylori therapy despite a high prevalence of antimicrobial resistance

Treatment of Helicobacter pylori infection 2017

Empirical Helicobacter pylori rescue therapy: an 18‐year single‐centre study of 1200 patients

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