Randomized study comparing omeprazole with ranitidine as anti‐secretory agents combined in quadruple second‐line <i>Helicobacter pylori</i> eradication regimens

Michopoulos, Spyros; Tsibouris, Panayiotis; Bouzakis, H.; Balta, Angeliki; Vougadiotis, J; Broutet, Nathalie; Kralios, N.

doi:10.1046/j.1365-2036.2000.00761.x

Cited by 46 publications

(45 citation statements)

References 25 publications

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“…While the adverse event rate in the 14-d bismuthbased quadruple therapy group in the present study was higher than that of the 7-d therapy group, the difference was not statistically significant. Adverse events are known to be dosage and durationdependent [38] ; thus, the most serious adverse events were expected to occur during the second week of treatment. Contrary to previous studies [38] , most adverse events in the present study, both mild-tomoderate, as well as serious adverse events leading to discontinuation of treatment, appeared during the early treatment stages.…”

Section: Adverse Events and Compliancementioning

confidence: 99%

“…Adverse events are known to be dosage and durationdependent [38] ; thus, the most serious adverse events were expected to occur during the second week of treatment. Contrary to previous studies [38] , most adverse events in the present study, both mild-tomoderate, as well as serious adverse events leading to discontinuation of treatment, appeared during the early treatment stages. These findings may explain the statistically insignificant differences in adverse event rates between the two groups, suggesting that if no serious adverse events appear within the first 7 d of 14-d bismuth-based quadruple therapy, then the probability of any serious adverse events occurring is relatively low.…”

Section: Adverse Events and Compliancementioning

confidence: 99%

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Fourteen-vsseven-day bismuth-based quadruple therapy for second-lineHelicobacter pylorieradication

Hwang

Lee

et al. 2015

WJG

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AIM:To compare the efficacy of 14-and 7-d bismuthbased quadruple therapies as second-line eradication treatment for Helicobacter pylori (H. pylori ) infection. METHODS:Between 2004 and 2014, the medical records of 790 patients who had experienced failure of first-line proton pump inhibitor (PPI)-based eradication therapy and were then treated with bismuth-based quadruple therapy were retrospectively reviewed. Those who received bismuth-based quadruple therapy [PPI, bismuth, metronidazole, and tetracycline (PBMT)] for either 7 d or 14 d were assigned to a PBMT-7 group (n = 543) or a PBMT-14 group (n = 247), respectively. The eradication rates for both groups were determined by intention-to-treat (ITT) and per-protocol (PP) analyses. ITT analysis compared the treatment groups as originally allocated while the PP analysis including only those patients who had completed the treatment as originally allocated. Successful eradication therapy for H. pylori infection was defined as a negative 13 C-urea breath test 4 wk after the end of eradication treatment. RESULTS:The overall ITT eradication rate was 69.1% (546/790). Final ITT eradication rates were 67.4% (366/543; 95%CI: 63.1%-71.7%) in the PBMT-7 group and 72.8% (180/247; 95%CI: 67.4%-78.2%) in the PBMT-14 group (P = 0.028). The overall PP eradication rate was 80.0% (546/682), and the final PP eradication rates were 78.2% (366/468; 95%CI: 72.1%-84.0%) in the PBMT-7 group and 84.1% (180/214; 95%CI: 76.8%-90.8%) in the PBMT-14 group (P = 0.009). The H. pylori eradication rates in the PBMT-14 group were Retrospective Study ORIGINAL ARTICLEsignificantly higher than in the PBMT-7 group according to both ITT (P = 0.028) and PP analysis (P = 0.009). Compliance was similar in both groups (PBMT-7 group: 97.9%; PBMT-14 group: 96.4%). Adverse event rates were 10.7% (51/478) and 17.1% (38/222) in the PBMT-7 and PBMT-14 groups, respectively (P = 0.487). CONCLUSION:

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Section: Adverse Events and Compliancementioning

confidence: 99%

Section: Adverse Events and Compliancementioning

confidence: 99%

Fourteen-vsseven-day bismuth-based quadruple therapy for second-lineHelicobacter pylorieradication

Hwang

Lee

et al. 2015

WJG

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“…and ranitidine 300 mg twice daily. were equally effective as antisecretory agents combined in a second-line quadruple eradication regimen after failure with previous regimens without metronidazole (although the power of the study to find statistically significant differences was limited) [Michopoulos et al 2000]. Nevertheless, these regimens were administered during 14 days and, therefore, remains to be demonstrated if the equivalence between both antisecretors PPIs and H 2 -blockers is also observable with 7-day regimens.…”

Section: Introductionmentioning

confidence: 99%

Review: Second-line rescue therapy of Helicobacter pylori infection

Gisbert

2009

Therap Adv Gastroenterol

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Helicobacter pylori infection is the main known cause of gastritis, gastroduodenal ulcer disease and gastric cancer. After more than 20 years of experience in H. pylori treatment, however, the ideal regimen to treat this infection has still to be found. Nowadays, apart from having to know well first-line eradication regimens, we must also be prepared to face treatment failures. Therefore, in designing a treatment strategy we should not focus on the results of primary therapy alone, but also on the final (overall) eradication rate. The choice of a 'rescue' treatment depends on which treatment is used initially. If a first-line clarithromycin-based regimen was used, a second-line metronidazole-based treatment (quadruple therapy) may be used afterwards, and then a levofloxacin-based combination would be a third-line 'rescue' option. Alternatively, it has recently been suggested that levofloxacin-based 'rescue' therapy constitutes an encouraging second-line strategy, representing an alternative to quadruple therapy in patients with previous PPI-clarithromycin-amoxicillin failure, with the advantage of efficacy, simplicity and safety. In this case, quadruple regimen may be reserved as a third-line 'rescue' option. Finally, rifabutin-based 'rescue' therapy constitutes an encouraging empirical fourth-line strategy after multiple previous eradication failures with key antibiotics such as amoxicillin, clarithromycin, metronidazole, tetracycline, and levofloxacin. Even after two consecutive failures, several studies have demonstrated that H. pylori eradication can finally be achieved in almost all patients if several 'rescue' therapies are consecutively given. Therefore, the attitude in H. pylori eradication therapy failure, even after two or more unsuccessful attempts, should be to fight and not to surrender.

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“…• Another alternative, the use of quadruple therapy (that is, PPI, bismuth, tetracycline, and metronidazole), has been generally used as the optimal second-line therapy after PPI-clarithromycin-amoxicillin failure, and it has been the recommended rescue regimen in several guidelines. Several studies have obtained relatively good results with this quadruple regimen, the results being summarized in Table 1 [10,13-16,17•,18••, [19][20][21]. Thus, the weighted mean eradication rate with this rescue therapy, which is calculated from the studies included in Table 1, is 77.2% (95% confidence interval, 72%-82%).…”

Section: Pharmacologic Treatmentmentioning

confidence: 98%

Treatment of helicobacter pylori eradication failures

Gisbert

2003

Curr Treat Options Gastro

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Even with the current most effective treatment regimens, about 10% to 20% of patients will fail to eradicate Helicobacter pylori infection. Therefore, in designing a treatment strategy, we should not focus on the results of primary therapy alone but also on the final (overall) eradication rate. The choice of a second-line treatment depends on which treatment was used initially, because retreatment with the same regimen is not recommended. Therefore, it seems that performing culture after a first eradication failure is not necessary and assessing H. pylori sensitivity to antibiotics only after failure of the second treatment is suggested in clinical practice. Different possibilities of empirical treatment are suggested. After failure of proton pump inhibitor (PPI)-amoxicillin-clarithromycin, quadruple therapy has been generally used. More recently, replacing the PPI and the bismuth compound by ranitidine bismuth citrate has also achieved good results. After PPI-amoxicillin-nitroimidazole failure, retreatment with PPI-amoxicillin-clarithromycin has proved to be effective. Finally, the first therapy should not combine clarithromycin and metronidazole in the same regimen because of the problem of resistance against both antibiotics. Recently, rifabutin-based rescue therapies have been shown to constitute an encouraging strategy for eradication failures because they are effective for H. pylori strains resistant to antibiotics.

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Randomized study comparing omeprazole with ranitidine as anti‐secretory agents combined in quadruple second‐line Helicobacter pylori eradication regimens

Cited by 46 publications

References 25 publications

Fourteen-vsseven-day bismuth-based quadruple therapy for second-lineHelicobacter pylorieradication

Fourteen-vsseven-day bismuth-based quadruple therapy for second-lineHelicobacter pylorieradication

Review: Second-line rescue therapy of Helicobacter pylori infection

Treatment of helicobacter pylori eradication failures

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