Randomised clinical trial: comparative study of 10‐day sequential therapy with 7‐day standard triple therapy for <i>Helicobacter pylori</i> infection in naïve patients

Park, H. G.; Jung, Min Kyu; Jung, Jin Tae; Kwon, Joong Goo; Kim, E. Y.; Seo, Hyang Eun; Lee, Joong Ho; Yang, Chang Heon; Kim, E. S.; Cho, K. B.; Park, K. S.; Lee, S. H.; Kim, K. O.; Jeon, Seong Woo

doi:10.1111/j.1365-2036.2011.04902.x

Cited by 76 publications

(44 citation statements)

References 50 publications

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“…In Korea, a study compared the eradication rate of the 10-day sequential therapy with that of the 14-day standard therapy and found a significantly higher rate of eradication in the sequential group (92.6 vs 85%) with no difference in adverse events [11]. Two other studies from Korea compared sequential therapy to a 7-day standard regime and also showed superior eradication in favor of sequential therapy [12,13]. In Taiwan, sequential therapy was also superior to standard triple therapy (93 vs 80%) with similar rates of adverse events and compliance [14].…”

Section: Triple Therapymentioning

confidence: 99%

Treatment of Helicobacter pylori infection 2012

et al. 2012

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Helicobacter pylori resistance rates to antibiotics vary in different countries and even in different regions of the same country. Choice of treatment is strongly dependent on antibiotic resistance rates. In some countries, triple therapy with a proton-pump inhibitor, amoxicillin, and clarithromycin is still the best option, but eradication results fall short of what would be desired (90-95%) in countries with clarithromycin resistance >20%, bismuth-containing quadruple therapy, or nonbismuth sequential or concomitant therapies may then be the preferred option. Newer antibiotic regimens are awaited. Vaccination would be the best option, especially for developing countries, but little progress has been made in designing a vaccine.A considerable amount of work has been conducted over the last year assessing many issues around Helicobacter pylori eradication therapy. These focussed primarily on assessing the efficacy of current standard triple therapy and exploring new first-line treatments. There was also progress in investigating antibiotic resistance rates, and the rescue therapies required to deal with ensuing treatment failures. There has also been an evolution in the use of adjunctive therapies. This article will address the published literature over the last year pertaining to these topics. Triple TherapyNumerous studies over the last year have assessed the efficacy of standard triple therapy with amoxicillin, clarithromycin, and a proton-pump inhibitor for the eradication of H. pylori, which have been perceived to be in decline in recent years. One such study looked at cure rates reported in all published literature from Spain between 1997 and 2008 and found that while cure rates have in fact been stable over that period, they remain inadequate with a mean cure rate of 80% by intention-to-treat and 83% by per-protocol [1]. Similar results were obtained from a multicenter study in Japan that revealed an eradication rate of 80.7% with an incidence of adverse drug reactions of 4.4% [2]. Other studies have looked at whether the efficacy of triple therapy can be improved by prolonging the course of therapy. In China, a study of shorter regimens showed eradication rates of 76, 89, and 91% for 3-day, 5-day, and 7-day regimens, respectively [3]. Increasing efficacy by prolongation of therapy was also noted in Greek patients, with eradication rates of 74.5% for 7 days, 80.6% for 10 days, and 90.2% for 14 days of therapy [4]. Another study showed that efficacy could be maintained when lower doses of medications were given, which reduced costs and side effects with cure rates of 77.2% for 10 mg rabeprazole, 500 mg amoxicillin, and 250 mg clarithromycin vs 78.9% for the standard 20 mg, 1 g, and 500 mg doses of these drugs [5].Regardless of the type of therapy used, study from Canada showed widespread failure to comply with test and treat in up to 10% of cases and a failure to confirm eradication in 32% [6]. This illustrates that efficacious first-line therapy will always depend on adherence to guidelines by phy...

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Section: Triple Therapymentioning

confidence: 99%

Treatment of Helicobacter pylori infection 2012

et al. 2012

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“…8,9 These results were attributed to the increased resistance of H. pylori to antibiotics, especially clarithromycin and metronidazole, in our province. In the 1990s, a high-dose proton pump inhibitor (PPI)-amoxicillin dual therapy was introduced as one of the alternative first-line therapies based on the theoretical studies showing that amoxicillin has a lower incidence of resistance compared with clarithromycin or metronidazole, and that its bactericidal effect can be amplified by increasing the maximum intragastric pH using high-dose PPI.…”

Section: Introductionmentioning

confidence: 92%

High and Frequent Dose of Dexlansoprazole and Amoxicillin Dual Therapy for Helicobacter pylori Infections: A Single Arm Prospective Study

Park

Kang

Kim

et al. 2017

Korean J Gastroenterol

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Background/Aims: Recently, the eradication rate of Helicobacter pylori (H. pylori) infection has decreased to less than 80% worldwide with the use of clarithromycin-based triple therapy owing to the increased resistance of H. pylori to antibiotics, especially clarithromycin and metronidazole. This prospective study aimed to determine eradication rate of H. pylori following high and frequent doses of extended-release dexlansoprazole and amoxicillin, as a dual therapy in a region with high clarithromycin resistance rate. Methods: A total of 50 treatment-naïve patients with active H. pylori infections, who were confirmed through via rapid urease test or histology and serology between November 2015 and February 2016 at our hospital, were included for analysis. All enrolled patients were treated with 750 mg amoxicillin and 30 mg dexlansoprazole, four times a day for a total duration of 14 days. Treatment success was determined using urea breath test four weeks after treatment completion. Results: Seven out of the 50 patients (29 men and 21 women; mean age, 57 years) dropped out during the study. The total eradication rate was 52% (26/50), and that for those with a compliance rate of over 90% was 68.4% (26/38). H. pylori infections were not successfully eradicated in patients with a compliance rate of less than 90%. Nine patients (18%) reported side effects, such as mild diarrhea and abdominal fullness. No significant factors, such as smoking and alcohol consumption, affected the infection the eradication rate. Conclusions: High and frequent doses of proton pump inhibitor-amoxicillin dual therapy were not effective in eradicating H. pylori infection in a province with high clarithromycin resistance rate. (Korean J Gastroenterol 2017;70:176-180)

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“…However, more recent studies have questioned both the optimal performance rates and the superiority of sequential therapy compared to legacy triple therapy [37,38] . Indeed, a recent multicenter South American randomized trial demonstrated that 14-d standard triple therapy was more efficacious than the 10-d sequential regimen [17] .…”

Section: Standard Sequential Therapymentioning

confidence: 98%

Eradication ofHelicobacter pyloriinfection: Which regimen first?

Federico

Gravina

Miranda

et al. 2014

WJG

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Helicobacter pylori (H. pylori) is a well-known human pathogen that plays an essential role in the pathogenesis of chronic gastritis, peptic ulcer disease, and gastric malignancies. Although H. pylori is susceptible to several antimicrobials, this infection has proven challenging to cure because of the increasing prevalence of bacterial strains that are resistant to the most commonly used antimicrobials, particularly clarithromycin. An effective (i.e., > 90%) first-line therapy is mandatory for avoiding supplementary treatments and testing, and more importantly for preventing the development of secondary resistance. This study reviews the recent literature on first-line therapies for H. pylori. The eradication rates following standard triple therapy (a proton pump inhibitor plus amoxicillin and clarithromycin) for H. pylori infection are declining worldwide. Several first-line strategies have been proposed to increase the eradication rate, including extending the treatment duration to 14 d, the use of a four-drug regimen (bismuth-containing quadruple, sequential, and concomitant treatments), and the use of novel antibiotics, such as fluoroquinolones. However, the efficacy of these regimens is controversial. A first-line eradication regimen should be based on what works best in a defined geographical area and must take into account the prevalence of antimicrobial resistance in that region.

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Randomised clinical trial: comparative study of 10‐day sequential therapy with 7‐day standard triple therapy for Helicobacter pylori infection in naïve patients

Abstract: SUMMARY BackgroundThe eradication rates following standard triple therapy for Helicobacter pylori infection are declining worldwide. Recent studies have shown that sequential therapy for H. pylori infection yields high cure rates.

Cited by 76 publications

References 50 publications

Treatment of Helicobacter pylori infection 2012

Treatment of Helicobacter pylori infection 2012

High and Frequent Dose of Dexlansoprazole and Amoxicillin Dual Therapy for Helicobacter pylori Infections: A Single Arm Prospective Study

Eradication ofHelicobacter pyloriinfection: Which regimen first?

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