Pooled analysis on the efficacy of the second line treatment regimens for Helicobacter pylori infection

Hojo, Mariko; Miwa, Hiroto; Nagahara, Akihito; Ohkura, Ryuichi; Murai, Toshio; Sato, Nobuhiro

doi:10.1016/s0016-5085(08)82895-8

Cited by 45 publications

(68 citation statements)

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“…14,16,28 Another argument for resistance as the predominant determinant of treatment failure is the high ef®cacy of proton pump inhibitor±clarithromycin±amoxicillin triple therapy as second-line treatment in several studies after an initial treatment not containing clarithromycin. 29 By contrast, proton pump inhibitor±clarithromy-cin±amoxicillin triple therapy after an initial treatment containing clarithromycin resulted in H. pylori cure rates below 40% in other studies. 30,31 The doubled dose of proton pump inhibitor in the OCA scheme of our study did not contribute to overcome the negative impact of clarithromycin resistance, although three randomized studies have demonstrated that the co-administration of a proton pump inhibitor considerably reduces the impact of clarithromycin resistance compared to sole antibiotic therapy.…”

Section: Discussionmentioning

confidence: 91%

High rate of post‐therapeutic resistance after failure of macrolide–nitroimidazole triple therapy to cure Helicobacter pylori infection: impact of two second‐line therapies in a randomized study

Peitz

Sulliga

Wolle

et al. 2002

Aliment Pharmacol Ther

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Background: The optimal second‐line treatment after failed Helicobacter pylori therapy has not been established. Aims: To ascertain whether quadruple therapy or triple therapy with omeprazole, clarithromycin and amoxicillin is the superior re‐treatment after triple therapy containing a macrolide and a nitroimidazole, and to determine the impact of microbial in vitro resistance. Methods: Patients after failed triple therapy were randomly allocated to one of two 1‐week second‐line treatments: omeprazole, 40 mg, clarithromycin, 500 mg, and amoxicillin, 1 g, all b.d.; or omeprazole, 20 mg b.d., bismuth subsalicylate, 600 mg q.d.s., metronidazole, 400 mg t.d.s., and tetracycline, 500 mg q.d.s. Post‐therapeutic Helicobacter pylori status was assessed by 13C‐urea breath test at least 4 weeks after treatment. Results: The study was terminated after including 84 patients. H. pylori cure rates differed significantly: omeprazole–clarithromycin–amoxicillin: intention‐to‐treat, 43%; per protocol, 50%; omeprazole–bismuth subsalicylate–metronidazole–tetracycline: intention‐to‐treat, 68%; per protocol, 69%. The frequencies of resistance after first‐line therapy were: metronidazole, 90%; clarithromycin, 71%; both combined, 68%. For clarithromycin resistance, H. pylori cure with omeprazole–clarithromycin–amoxicillin was 30% vs. 83% for clarithromycin susceptibility. Conclusions: Omeprazole–bismuth subsalicylate–metron‐ idazole–tetracycline was superior to omeprazole–clarithromycin–amoxicillin, but both therapies yielded unsatisfactory results. The high rate of post‐therapeutic dual resistance has a negative impact on omepraz‐ ole–clarithromycin–amoxicillin, and probably also on omeprazole–bismuth subsalicylate–metronidazole–tetracycline, and limits the choice for second‐line treatment.

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Section: Discussionmentioning

confidence: 91%

High rate of post‐therapeutic resistance after failure of macrolide–nitroimidazole triple therapy to cure Helicobacter pylori infection: impact of two second‐line therapies in a randomized study

Peitz

Sulliga

Wolle

et al. 2002

Aliment Pharmacol Ther

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“…The traditional re-treatment formulas (i.e. PPI-based dual therapy, PPI-based triple therapy, ranitidine bismuth-based triple therapy, and quadruple therapy) provide eradication rates of 45.8%, 69.8%, 80.2%, and 75.8%, respectively [10].…”

Section: Discussionmentioning

confidence: 99%

A Community‐Based Study of Helicobacter pylori Therapy Using the Strategy of Test, Treat, Retest, and Re‐treat Initial Treatment Failures

Lee

Chen

et al. 2006

Helicobacter

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“…Those patients have a high risk for the recurrence of ulcer and its complications. A systematic review that included 16 studies and 24 abstracts estimated that eradication rates were 46, 70, 80, and 76% for PPI-based dual therapy, PPI-based triple therapy, ranitidine bismuth citrate-based triple therapy, and quadruple therapy, respectively [16].…”

Section: Discussionmentioning

confidence: 99%

A Randomized Controlled Trial: Efficacy and Safety of Azithromycin, Ofloxacin, Bismuth, and Omeprazole Compared With Amoxicillin, Clarithromycin, Bismuth, and Omeprazole as Second‐Line Therapy in Patients With Helicobacter pylori Infection

et al. 2010

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Pooled analysis on the efficacy of the second line treatment regimens for Helicobacter pylori infection

Cited by 45 publications

References 0 publications

High rate of post‐therapeutic resistance after failure of macrolide–nitroimidazole triple therapy to cure Helicobacter pylori infection: impact of two second‐line therapies in a randomized study

High rate of post‐therapeutic resistance after failure of macrolide–nitroimidazole triple therapy to cure Helicobacter pylori infection: impact of two second‐line therapies in a randomized study

A Community‐Based Study of Helicobacter pylori Therapy Using the Strategy of Test, Treat, Retest, and Re‐treat Initial Treatment Failures

A Randomized Controlled Trial: Efficacy and Safety of Azithromycin, Ofloxacin, Bismuth, and Omeprazole Compared With Amoxicillin, Clarithromycin, Bismuth, and Omeprazole as Second‐Line Therapy in Patients With Helicobacter pylori Infection

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