Pretreatment Antimicrobial Susceptibility-Guided Vs. Clarithromycin-Based Triple Therapy for Helicobacter pylori Eradication in a Region With High Rates of Multiple Drug Resistance

Park, Chung-Su; Lee, Su-Mi; Park, Chang-Hwan; Koh, Han-Ra; Jun, Chung‐Hwan; Seon-Young, Park; Lee, Wan‐Sik; Joo, Young‐Eun; Kim, Hyunsoo; Choi, Sung‐Kyu; Rew, Jong Sun

doi:10.1038/ajg.2014.222

Cited by 76 publications

(76 citation statements)

References 29 publications

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“…The eradication rates of susceptibility-guided treatments are generally higher than those of empirical treatment regimens[7,81,86]. Recent studies have also shown that susceptibility-based treatment improves the efficacy of the therapy used after first- or second-line treatment failure as well as the efficacy of first-line therapy (Tables 1 and 2)[26,73,82-84,87-92]. A meta-analysis of five randomized controlled trials concluded that the culture-based pretreatment success rates were 16% higher than those of various standard triple therapies used as the first-line treatment for H. pylori infection in 701 patients (per protocol 93% vs 76%)[6,9,82].…”

Section: Contribution Of Antimicrobial Susceptibility Testing To the mentioning

confidence: 99%

Importance of antimicrobial susceptibility testing for the management of eradication inHelicobacter pyloriinfection

Arslan

Yılmaz

Demiray-Gürbüz

2017

WJG

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The management of Helicobacter pylori (H. pylori) infection treatment differs from the common treatment protocol for other infectious diseases. Because culture- or molecular-guided approaches face several practical issues, such as the invasive procedures required to obtain gastric biopsy specimens and the lack of availability of routine laboratory testing in some places, H. pylori treatment includes the administration of two or three empirically selected antibiotics combined with a proton pump inhibitor rather than evidence-based eradication treatment. The efficacy of empirical therapy is decreasing, mostly due to increasing multiple resistance. Multiresistance to levofloxacin, clarithromycin, and metronidazole, which are commonly used in empirical treatments, appears to have increased in many countries. Mutations play a primary role in the antimicrobial resistance of H. pylori, but many different mechanisms can be involved in the development of antibiotic resistance. Determining and understanding these possible mechanisms might allow the development of new methods for the detection of H. pylori and the determination of antimicrobial resistance. A treatment based on the detection of antimicrobial resistance is usually more effective than empirical treatment. Nevertheless, such an approach before treatment is still not recommended in the Maastricht guidelines due to the difficulty associated with the routine application of available culture- or molecular-based susceptibility tests, which are usually administered in cases of treatment failure. The management of first and rescue treatments requires further research due to the steadily increase in antimicrobial resistance.

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Section: Contribution Of Antimicrobial Susceptibility Testing To the mentioning

confidence: 99%

Importance of antimicrobial susceptibility testing for the management of eradication inHelicobacter pyloriinfection

Arslan

Yılmaz

Demiray-Gürbüz

2017

WJG

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“…We used the success rate of H. pylori eradication by the first regimen (lansoprazole 30 mg bid, amoxicillin 750 mg or 1000 mg bid, and CAM 200 mg or 500 mg bid for one week) including CAM in the patients with CAM-sensitive or CAM-resistant H. pylori [12–15]. We also used success rate of metronidazole included triple therapy (omeprazole 20 mg bid or lansoprazole 30 mg bid, amoxicillin 500 or 750 mg bid, metronidazole 500 mg in the morning and 250 mg in the evening or 250 mg tid for one week) in the patients with CAM-sensitive or CAM-resistant H. pylori [16].…”

Section: Methodsmentioning

confidence: 99%

Cost-Effectiveness Analysis ofHelicobacter pyloriDiagnostic Methods in Patients with Atrophic Gastritis

Shimbo

Ohde

Deshpande

et al. 2017

Gastroenterology Research and Practice

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Background. There are several diagnostic methods for Helicobacter pylori (H. pylori) infection. A cost-effective analysis is needed to decide on the optimal diagnostic method. The aim of this study was to determine a cost-effective diagnostic method in patients with atrophic gastritis (AG). Methods. A decision-analysis model including seven diagnostic methods was constructed for patients with AG diagnosed by esophagogastroduodenoscopy. Expected values of cost and effectiveness were calculated for each test. Results. If the prevalence of H. pylori in the patients with AG is 85% and CAM-resistant H. pylori is 30%, histology, stool H. pylori antigen (SHPAg), bacterial culture (BC), and urine H. pylori antibody (UHPAb) were dominated by serum H. pylori IgG antibody (SHPAb), rapid urease test (RUT), and urea breath test (UBT). Among three undominated methods, the incremental cost-effective ratios (ICER) of RUT versus SHPAb and UBT versus RUT were $214 and $1914, respectively. If the prevalence of CAM-sensitive H. pylori was less than 55%, BC was not dominated, but its H. pylori eradication success rate was 0.86. Conclusions. RUT was the most cost-effective at the current prevalence of CAM-resistant H. pylori. BC could not be selected due to its poor effectiveness even if CAM-resistant H. pylori was more than 45%.

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“…The TSG and palmatine groups were treated intragastrically with 4 g/kg and 50 mg/kg daily for 1 week, respectively. The triple therapy group was treated intragastrically with a suspension of omeprazole (0.8 μg/kg), clarithromycin (20 μg/kg), and amoxicillin (40 μg/kg) daily for 1 week [26]. The SS1 model group, the SCYA201401 model group, and blank control group were given saline solution.…”

Section: Methodsmentioning

confidence: 99%

In vitro and in vivo bactericidal activity of Tinospora sagittata (Oliv.) Gagnep. var. craveniana (S.Y.Hu) Lo and its main effective component, palmatine, against porcine Helicobacter pylori

Rong

Dong

et al. 2016

BMC Complement Altern Med

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BackgroundTinospora sagittata (Oliv.) Gagnep. var. craveniana (S.Y.Hu) Lo (TSG) is a traditional Chinese herb that has been used for the treatment of upper respiratory tract infection and has anti-bacterial and anti-ulcer activity. Our study investigated the bactericidal effects of TSG and its major component, palmatine, against a Helicobacter pylori (H. pylori) strain isolated from pig and the standard strain H. pylori SS1 in vitro and in vivo.MethodsH. pylori was isolated from pig and named H. pylori SCYA201401. For in vitro experiments, the inhibitory activity of TSG and palmatine against H. pylori SCYA201401 and H. pylori SS1 were tested by use of the agar cup diffusion technique. The minimal inhibitory concentration (MIC) and minimal bactericidal concentration (MBC) were determined from the absence of H. pylori colonies on agar plates. Time-kill curves were used to evaluate bactericidal activity; the average number of colonies was calculated at 0 to 48 h after liquid incubation, with concentrations of drugs at 0.5, 1, and 2 × MIC. For in vivo experiments, H. pylori SCYA201401-infected mice were randomly divided into TSG, palmatine, triple therapy (omeprazole, clarithromycin, and amoxicillin), blank control, and model groups. The eradication ratios were determined by use of rapid urease tests and bacterial culture.ResultsIn vitro, the MIC and MBC of TSG against H. pylori SCYA201401 and SS1 were both 6250 μg/mL, whereas palmatine against H. pylori SCYA201401 was 6.25 μg/mL and against H. pylori SS1 was 3.12 μg/mL. The time-kill curves showed a dose-dependent, progressive decline in the numbers of viable bacteria up to 40 h. In vivo, the eradication ratios in the TSG and palmatine groups of mice were 80 and 50 % compared with 70 % in the triple-therapy group.ConclusionTSG and its major component, palmatine, have bactericidal activity against H. pylori in vitro and in vivo. The possibility that TSG or palmatine can be effective in the treatment of human and animals H. pylori infection deserves investigation.

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Pretreatment Antimicrobial Susceptibility-Guided Vs. Clarithromycin-Based Triple Therapy for Helicobacter pylori Eradication in a Region With High Rates of Multiple Drug Resistance

Abstract: Pretreatment antimicrobial susceptibility-guided therapy is more effective than clarithromycin-based triple therapy for H. pylori eradication in a region with high rates of multiple drug resistance.

Cited by 76 publications

References 29 publications

Importance of antimicrobial susceptibility testing for the management of eradication inHelicobacter pyloriinfection

Importance of antimicrobial susceptibility testing for the management of eradication inHelicobacter pyloriinfection

Cost-Effectiveness Analysis ofHelicobacter pyloriDiagnostic Methods in Patients with Atrophic Gastritis

In vitro and in vivo bactericidal activity of Tinospora sagittata (Oliv.) Gagnep. var. craveniana (S.Y.Hu) Lo and its main effective component, palmatine, against porcine Helicobacter pylori

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