Randomized trial of omeprazole and metronidazole with amoxycillin or clarithromycin for Helicobacter pylori eradication, in a region of high primary metronidazole resistance: the HERO study

Abstract

OMC is a well-tolerated, effective therapy for H. pylori eradication and duodenal ulcer healing in this region despite the high metronidazole resistance rate. OAM is less effective, largely due to the impact of metronidazole resistance.

Vitamin B 6 Is Required for Full Motility and Virulence in Helicobacter pylori

“…There are currently only a limited number of antibiotics suitable for the routine treatment of Helicobacter pylori infection; moreover, the efficacies of these compounds have been severely hindered by the rise in resistance among H. pylori isolates (1, 2). It is therefore necessary to develop novel therapeutic and prophylactic strategies for the management of H. pylori -related disease.…”

A prospective evaluation of levofloxacin‐based triple therapy for refractory Helicobacter pylori infection in Australia

“…The study demonstrates a high eradication rate with good tolerability and safety. 6,10 We reported a per-protocol eradication rate of 76% for a rifabutin triple therapy and 84% with a bismuth-based quadruple therapy, both given as salvage therapy. The eradication rate achieved exceeds the 80% threshold often considered an appropriate benchmark for the adequacy of an eradication therapy.…”

Helicobacter pylori: Antibiotic resistance and treatment options

“…5 The discovery of Helicobacter pylori by Warren and Marshall over two decades ago, and the subsequent emergence of triple therapy for PUD treatment in patients infected with H. pylori, have contributed to the decline in bleeding from PUD as a common medical emergency. 6 However, this has been counterbalanced by a number of factors which increase the propensity of PUD development and its complications. These include the aging population in most developed nations, 7 the utilization of non-steroidal antiinflammatory drugs (NSAIDs) for several disorders, and the aggressive utilization of anti-platelet therapy in a variety of vascular conditions, in particular post-endovascular stenting in ischemic heart disease.…”

“…Given the known high MR rates, these combinations are no longer recommended for first-line therapy in Australia. [2][3][4][5][6] In many Asian countries and regions, the community exposure to antibiotics may be harder to ascertain, but given the availability and ease of access to antibiotics at the community level in many countries, it may be considerable also. Certainly, significant resistance has been reported from hospital surveys in many countries in the region.…”

“…Similarly, in Australia, somewhat surprisingly, high primary metronidazole resistance (MR) rates have been reported consistently from single centers and from multicenter surveys. 2,5,6 It transpires that there is a very large community exposure to monotherapy with nitroimidazole agents (predominantly metronidazole and tinidazole); nearly 1 million prescriptions for such compounds are written annually in a country of just 21 million people. 7 Many randomized controlled studies in Australia and elsewhere have documented the adverse impact on outcomes of primary MR on metronidazole containing triple therapies against H. pylori.…”