Optimized Nonbismuth Quadruple Therapies Cure Most Patients With Helicobacter pylori Infection in Populations With High Rates of Antibiotic Resistance

Molina–Infante, Javier; Romano, Marco; Fernandez–Bermejo, Miguel; Federico, Alessandro; Gravina, Antonietta Gerarda; Pozzati, Liliana; Garcia–Abadia, Elena; Vinagre-Rodríguez, Gema; Martínez-Alcalá, Carmen; Hernández-Alonso, Moisés; Miranda, Agnese; Iovene, Maria Rosaria; Pazos-Pacheco, Carmen; Gisbert, Javier P.

doi:10.1053/j.gastro.2013.03.050

Cited by 176 publications

(186 citation statements)

References 27 publications

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“…The so-called 10-day "concomitant" therapy (non-bismuth quadruple), although representing an option as first line therapy [10,52], has been used by our group in a previous trial [9] with eradication rates of 85.5% (ITT) and 91.6% (PP) but was not used in the present study.…”

Section: Discussionmentioning

confidence: 99%

Eradication Rates in Italian Subjects Heterogeneously Managed for Helicobacter pylori Infection. Time to Abandon Empiric Treatments in Southern Europe

Ciaula

Scaccianoce

Venerito

et al. 2017

JGLD

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Background & Aims: H. pylori eradication is strongly affected by various factors, including the ongoing antibiotic resistance. We describe a “real life” scenario in patients managed for H. pylori-related conditions, living in a southern Italian region (Apulia), an area with clarithromycin resistance >15%.Methods: 2,224 subjects were studied in two tertiary referral centers in Apulia. Analyses included: reason for referral, H. pylori infection rates (13C-urea breath test – UBT or upper endoscopy), and eradication rates following distinct regimens previously prescribed or prospectively prescribed (such as the bismuth-based quadruple therapy Pylera®, recently marketed in Italy).Results. Over 80% of the patients were referred by family physicians (60% naïve subjects). The overall infection rate was 32.5% and it was similar in asymptomatic patients (31.1%) or with H. pylori-related symptoms/clinical conditions (34.3%). In the 987 H. pylori+ve patients receiving therapy, the overall eradication rate was 80.2% (ITT). Observed eradication rate varied greatly across different regimens: 57.1% (2nd line levofloxacin), 59.6% (unconventional), 70.7% (7-day triple), 73.2% (7-day undefined), 89% (10-day sequential) and 96.9% (ITT, 10 day Pylera®, 1st to 5th line regimens given to 227 patients).Conclusions. A heterogeneous “real life” scenario in Southern Europe shows that H. pylori+ve patients are put at risk of poor outcomes and points to the need of a susceptibility-based therapy according to guidelines and local microbial resistance. In the present setting (i.e. high clarithromycin resistance), despite the high observed eradication rate, sequential therapy should not be recommended (absent in guidelines, unneeded antibiotic). Bismuth-based quadruple treatment (1st, 2nd or subsequent lines) yields the highest eradication rates.Abbreviations: ALT: Altamura; BA: Bari; EGDS: esophagogastroduodenoscopy; GERD: gastro-esophageal reflux disease; H. pylori: Helicobacter pylori; ITT: intention-to-treat; PP: per-protocol; PPI: proton pump inhibitor; UBT: urea breath test.

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Section: Discussionmentioning

confidence: 99%

Eradication Rates in Italian Subjects Heterogeneously Managed for Helicobacter pylori Infection. Time to Abandon Empiric Treatments in Southern Europe

Ciaula

Scaccianoce

Venerito

et al. 2017

JGLD

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“…Therefore, 10 RCTs (14-23) with 3,501 patients were included in the meta-analysis. The characteristics of the selected studies are summarized in Table. Of the 10 eligible studies, five RCTs (14,17,18,21,22) were conducted in Asia, four RCTs (15,19,20,23) were performed in Europe and one study (16) was carried out in Latin America; all studies were published in English (nine full-text articles and one abstract). A quality assessment of the included studies was performed using the Jadad score.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Three studies (15,20,23) compared concomitant therapy with hybrid therapy. In total, 480 patients were treated with concomitant therapy and 370 patients were treated with hybrid therapy.…”

Section: Concomitant Therapy Vs Hybrid Therapymentioning

confidence: 99%

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Meta-Analysis of Sequential, Concomitant and Hybrid Therapy for <i>Helicobacter pylori</i> Eradication

Deng

Luo

2015

Intern. Med.

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Objective To compare the efficacy of sequential therapy, concomitant therapy and hybrid therapy for the treatment of Helicobacter pylori (H. pylori) infection. Methods PubMed, Web of Science, Medline, Embase, the Cochrane Central Register of Controlled Trials and CNKI were searched up to the end of May 10, 2014 in order to identify all randomized controlled trials (RCTs) reporting the effects of sequential therapy, concomitant therapy and hybrid therapy on H. pylori eradication. The relative risk (RR) of eradicating H. pylori infection after sequential therapy compared with concomitant therapy or hybrid therapy was pooled. The eradication rates were considered both on an intention-to-treat (ITT) and per-protocol (PP) basis. Results A total of 10 RCTs involving 3,501 patients were included. The pooled data suggested that the differences between the three groups were not statistically significant (ITT analysis: sequential therapy vs. concomitant therapy: RR=1.01, 95%confidence interval (CI): 0.97-1.04, sequential therapy vs. hybrid therapy: RR=1.02, 95%CI: 0.85-1.22, concomitant therapy vs. hybrid therapy: RR=1.03, 95%CI: 0.97-1.08; PP analysis: sequential therapy vs. concomitant therapy: RR=1.00, 95%CI: 0.96-1.03, sequential therapy vs. hybrid therapy: RR=0.97, 95%CI: 0.86-1.09, concomitant therapy vs. hybrid therapy: RR=1.01, 95%CI: 0.93-1.10). In the ITT and PP analyses, the overall eradication rates were 84.3% (95%CI: 79.1-89.4) and 86.4% (95%CI: 81.7-91.0) for the sequential therapy group, 86.7% (95%CI: 81.0-92.3) and 89.8% (95%CI: 85.1-94.5) for the concomitant therapy group and 86.6% (95%CI: 82.3-91.0) and 92.7% (95%CI: 90.5-94.9) for the hybrid therapy group, respectively. There were no significant differences among these therapies in terms of the rate of side effects. Conclusion The pooled evidence suggests that sequential therapy, concomitant therapy and hybrid therapy are similar with respect to the treatment of H. pylori infection.

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“…The misuse of antimicrobials is a major cause of increased bacterial resistance in hospitals (3), which has led to an increased prevalence in drug-resistant strains (4). Thus, the proper choice of antimicrobial agents is of great importance in combating drug-resistant bacteria (5).…”

Section: Introductionmentioning

confidence: 99%

The Antibacterial Effects of Antimicrobial Peptides OP-145 against Clinically Isolated Multi-Resistant Strains

Liu

Huang

2017

Jpn J Infect Dis

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Optimized Nonbismuth Quadruple Therapies Cure Most Patients With Helicobacter pylori Infection in Populations With High Rates of Antibiotic Resistance

Cited by 176 publications

References 27 publications

Eradication Rates in Italian Subjects Heterogeneously Managed for Helicobacter pylori Infection. Time to Abandon Empiric Treatments in Southern Europe

Eradication Rates in Italian Subjects Heterogeneously Managed for Helicobacter pylori Infection. Time to Abandon Empiric Treatments in Southern Europe

Meta-Analysis of Sequential, Concomitant and Hybrid Therapy for <i>Helicobacter pylori</i> Eradication

The Antibacterial Effects of Antimicrobial Peptides OP-145 against Clinically Isolated Multi-Resistant Strains

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