Rabeprazole, Minocycline, Amoxicillin, and Bismuth as First‐Line and Second‐Line Regimens for <i>Helicobacter pylori</i> Eradication

Song, Zhiqiang; Suo, Baojun; Zhang, Lingyun; Zhou, Liya

doi:10.1111/hel.12313

Cited by 30 publications

(69 citation statements)

References 31 publications

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“…Educational levels were categorized by years of education (< 7, 7-9, 10-12, 13-16, or > 16 years). Poor adherence to H. pylori treatment was defined as patient reporting < 80% adherence of prescribed therapy[ 22 ]. Severe adverse event was defined as treatment-related adverse event necessitating discontinuation of therapy within 10 d.…”

Section: Methodsmentioning

confidence: 99%

Outcomes of furazolidone- and amoxicillin-based quadruple therapy forHelicobacter pyloriinfection and predictors of failed eradication

Zhang¹,

Hu²,

Cai³

et al. 2018

WJG

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AIMTo evaluate the outcomes of furazolidone- and amoxicillin-based quadruple therapy for treatment of Helicobacter pylori (H. pylori) infection and identify predictors of failed eradication.METHODSPatients with H. pylori infection treated with furazolidone, amoxicillin, bismuth, and proton pump inhibitor therapy (January 2015 to December 2015) who received the 13C-urea breath test > 4 wk after treatment were evaluated. Demographic and clinical data including prior H. pylori treatment attempts, medication adherence, alcohol and cigarette consumption during therapy, and treatment-related adverse events were recorded by reviewing medical records and telephone surveys. H. pylori eradication rates for overall and subgroups were evaluated. Multivariate analysis was performed to identify independent predictors of failed H. pylori eradication.RESULTSOf the 992 patients treated and retested for H. pylori infection, the overall eradication rate was 94.5% [95% confidence interval (CI): 94.1%-95.9%]. H. pylori eradication rate of primary therapy was 95.0% (95%CI: 93.5%-96.5%), while that of rescue therapy was 91.3% (95%CI: 86.8%-95.8%). Among the 859 patients who completed the study protocol, 144 (17%) reported treatment-related adverse events including 24 (3%) leading to premature discontinuation. On multivariate analysis, poor medication adherence [adjusted odds ratio (AOR) = 6.7, 95%CI: 2.8-15.8], two or more previous H. pylori treatments (AOR = 7.4, 95%CI: 2.2-24.9), alcohol consumption during therapy (AOR = 4.4, 95%CI: 1.5-12.3), and possibly smoking during therapy (AOR = 1.9, 95%CI: 0.9-4.3) were associated with failed H. pylori eradication.CONCLUSIONFurazolidone- and amoxicillin-based quadruple therapy for H. pylori infection in an area with a high prevalence of clarithromycin resistance demonstrated high eradication rates as primary and rescue therapies with a favorable safety profile. Patient education targeting abstinence from alcohol during therapy and strict medication adherence may further optimize H. pylori eradication.

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Section: Methodsmentioning

confidence: 99%

Outcomes of furazolidone- and amoxicillin-based quadruple therapy forHelicobacter pyloriinfection and predictors of failed eradication

Zhang¹,

Hu²,

Cai³

et al. 2018

WJG

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“…The rabeprazole group had eradication rates of 87.5% in first-line therapy and 82.9% for second-line. 58 The group receiving esomeprazole reported 85.5% eradication rates in first-line therapy and 82.8% for second-line. 59 A study from Croatia reported eradication rates of 80.64% for bismuth quadruple therapy with pantoprazole, metronidazole, and moxifloxacin.…”

Section: Bismuth-based Therapymentioning

confidence: 98%

“…A group from China reported two separate prospective studies from a region with high antibiotic resistance rates looking at bismuth‐based quadruple therapy for 14 days with minocycline, amoxicillin, and in one case rabeprazole and the other esomeprazole. The rabeprazole group had eradication rates of 87.5% in first‐line therapy and 82.9% for second‐line . The group receiving esomeprazole reported 85.5% eradication rates in first‐line therapy and 82.8% for second‐line .…”

Section: Bismuth‐based Therapymentioning

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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“…Support for the use of doxycycline in H. pylori eradication regimens was found in a meta‐analysis carried out this year which showed a pooled OR for eradication success rate of 1.292 . Another study looked at rabeprazole, minocycline, bismuth, and amoxicillin as both first‐ and second‐line treatment, finding eradication rates of 87.5% and 82.9%, respectively . A novel and very interesting study from Turkey looked at using bismuth as part of a 5‐day, 5‐drug concomitant regime with omeprazole, clarithromycin, amoxicillin, and metronidazole as a first‐line treatment and found excellent tolerability and efficacy with compliance rate of 97.3% and eradication at 93.1% .…”

Section: Bismuth Therapymentioning

confidence: 99%

“…51 Another study looked at rabeprazole, minocycline, bismuth, and amoxicillin as both first-and second-line treatment, finding eradication rates of 87.5% and 82.9%, respectively. 52 The anti-H. pylori mechanism of bismuth is not fully understood, but one mechanistic study carried out this year suggests it works by impeding proton entry into the bacteria, leading to a decrease in the expected fall in cytoplasmic pH. 56 With cytoplasmic pH remaining within range for increased metabolic activity of a neutralophil, the efficacy of growth-dependent antibiotics was augmented.…”

Section: Bismuth Therapymentioning

confidence: 99%

Treatment of Helicobacter pylori infection 2016

et al. 2016

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Many interesting articles have been published from different parts of the world over the last year assessing various issues around Helicobacter pylori eradication therapy. This article will address the published literature over the last year pertaining to the topic of treatment of H. pylori infection. The main themes that emerge are assessing the efficacy of standard triple therapy, as well as exploring new first-line treatments, mainly optimized nonbismuth-containing and bismuth-containing quadruple therapies with some promising data also emerging on dual therapy. There was also considerable progress in investigating antibiotic resistance rates with much more data emerging from varied parts of the world compared to recent years. Advances in the use of adjunctive therapies, especially probiotic therapies have also been made. Undoubtedly, the eradication of H. pylori remains a worthwhile goal to alleviate the burden of diseases caused by the complications of this infection, including dyspepsia, peptic ulcer disease, and gastric cancer.

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Rabeprazole, Minocycline, Amoxicillin, and Bismuth as First‐Line and Second‐Line Regimens for Helicobacter pylori Eradication

Abstract: The eradication efficacies of RMAB therapy as first-line and second-line regimens were satisfactory with good compliance and safety in a region with high antibiotic resistance.

Cited by 30 publications

References 31 publications

Outcomes of furazolidone- and amoxicillin-based quadruple therapy forHelicobacter pyloriinfection and predictors of failed eradication

Outcomes of furazolidone- and amoxicillin-based quadruple therapy forHelicobacter pyloriinfection and predictors of failed eradication

Treatment of Helicobacter pylori infection 2017

Treatment of Helicobacter pylori infection 2016

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