Safety of first-line triple therapy with a potassium-competitive acid blocker for Helicobacter pylori eradication in children

Kusano, Chika; Gotoda, Takuji; Suzuki, Shinichi; Ikehara, Hisatomo; Moriyama, Mitsuhiko

doi:10.1007/s00535-017-1406-2

Cited by 42 publications

(38 citation statements)

References 42 publications

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“…The limitations that we have identified in this meta‐analysis are: (1) because vonoprazan is currently only available in Japan, our findings may not be generalizable to other populations; (2) the recommended first‐line H. pylori eradication regimen in Japan is 7‐day triple therapy, which is not recommended in most of the current consensus; (3) because relevant RCTs are not abundant, our analysis included less RCT data than ideal; and (4) little data was available on children, so our findings may not be generalizable to children …”

Section: Discussionmentioning

confidence: 95%

“…B, Forest plot of meta-analysis using a random-effects model comparing between VPZ-based and conventional PPI-based H. pylori eradication triple therapy in patients with clarithromycin-susceptible strains from NRCT data. PPI, proton-pump inhibitor; VPZ, vonoprazan recommended first-line H. pylori eradication regimen in Japan is 7day triple therapy,10 which is not recommended in most of the current consensus; (3) because relevant RCTs are not abundant, our analysis included less RCT data than ideal; and (4) little data was available on children, so our findings may not be generalizable to children 43.…”

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confidence: 99%

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Systematic review with meta‐analysis: Vonoprazan, a potent acid blocker, is superior to proton‐pump inhibitors for eradication of clarithromycin‐resistant strains of Helicobacter pylori

et al. 2018

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Vonoprazan-based and conventional PPI-based therapies are similarly effective for the eradication of clarithromycin-susceptible H. pylori strains. Vonoprazan is superior to conventional PPI-based therapy for the eradication of clarithromycin-resistant H. pylori strains. However, clarithromycin was misused because the combination of vonoprazan and amoxicillin cures approximately 80% of infections without clarithromycin.

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Section: Discussionmentioning

confidence: 95%

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confidence: 99%

Systematic review with meta‐analysis: Vonoprazan, a potent acid blocker, is superior to proton‐pump inhibitors for eradication of clarithromycin‐resistant strains of Helicobacter pylori

et al. 2018

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“…6 In Japan, triple therapy with potassium-competitive acid blocker (P-CAB), amoxicillin, and clarithromycin is an established first-line treatment method in H. pylori-infected adults. 9 Changes and dysbiosis in gut microbiota composition or disruption of normal commensal relationships with the human host may induce the pathogenesis of various disorders. 9 Changes and dysbiosis in gut microbiota composition or disruption of normal commensal relationships with the human host may induce the pathogenesis of various disorders.…”

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confidence: 99%

Gut microbiome can be restored without adverse events after Helicobacter pylori eradication therapy in teenagers

et al. 2018

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Objectives The effect of Helicobacter pylori eradication on the gut microbiota of teenagers is unknown; hence, this study aimed to assess changes in the gut microbiome after H. pylori eradication therapy in teenagers. Materials and Methods Changes in gut microbiota before and after H. pylori eradication were prospectively investigated in eight students without any underlying diseases, via next‐generation sequencing of 16S rDNA. Twenty‐four stool samples were collected, and operational taxonomic unit analysis was performed. As secondary analyses, alpha and beta diversity were evaluated. Furthermore, pre‐treatment microbiome compositions were compared with those 1 week and 2 months after treatment. Results Alpha diversity analysis revealed that both species richness and evenness were recovered to pre‐treatment levels at 2 months after eradication therapy. Slight but non‐significant differences were observed in bacterial species abundance between pre‐ and post‐treatment samples, upon beta diversity analysis. Although the relative abundance of Bacteroidetes tended to increase and that of Actinobacteria significantly decreased immediately after eradication therapy, the taxonomic composition was similar to that before treatment and at 2 months post‐eradication. However, two students showed significant changes in the gut microbiota in relative abundances at the level of the phylum, class, and order. Conclusions Although H. pylori eradication therapy caused short‐term dysbiosis, microbial diversity was restored in healthy teenagers. However, as the relative abundance of gut microbiota in some cases remained altered, the effect of H. pylori eradication therapy on the gut microbiome should be continuously monitored.

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“…In two previous studies, although metronidazole was used as a second-line treatment after the failure of the first-line treatment based on clarithromycin, the eradication rate was nearly 100%. 11,15 These comparative effectiveness studies, although small in scale, provided evidence demonstrating the superiority of metronidazole in H pylori eradication therapy among children and adolescents, even based on known results of susceptibility tests. 11 Further accumulation of efficacy data on metronidazole in children is warranted.…”

Section: Effic Ac Y and Adver S E Effec Ts Of Me Tronida Zole-contamentioning

confidence: 99%

Metronidazole for Helicobacter pylori eradication therapy among children and adolescents in Japan: Overcoming controversies and concerns

et al. 2019

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Background Metronidazole is an antiprotozoal drug used to treat a broad spectrum of infectious diseases, including Helicobacter pylori (H pylori) infections. In Japan, metronidazole is approved for the eradication therapy of H pylori as a second‐line regimen among adults, but it has not yet been approved for use among children and adolescents. Materials and Methods To perform this narrative review, we searched the relevant literature on important events in the history of the use of metronidazole, its mechanisms of action, its efficacy, and the adverse effects reported in clinical trials or cohort studies in Japan. Results At present, metronidazole resistance has not been a serious issue in Japan in large part due to its restricted use. Emerging evidence from randomized controlled trials demonstrates higher eradication rates for metronidazole than for clarithromycin, supporting its use in both first‐line and second‐line eradication therapies. Among the reported adverse effects, there has been lingering concern over the potential carcinogenicity of metronidazole in humans. However, the possibility of an increased cancer risk is not limited to metronidazole; the long‐term use of antibiotics has been linked to increased risk for some site‐specific cancers. However, recent prospective studies have suggested that short‐term exposure to antibiotics is not associated with an increased cancer risk. Conclusion Sensible use of metronidazole backed by research evidence could maximize the benefits associated with H pylori eradication in Japan.

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Safety of first-line triple therapy with a potassium-competitive acid blocker for Helicobacter pylori eradication in children

Abstract: First-line triple therapy with a P-CAB for H. pylori eradication in children was found to be safe.

Cited by 42 publications

References 42 publications

Systematic review with meta‐analysis: Vonoprazan, a potent acid blocker, is superior to proton‐pump inhibitors for eradication of clarithromycin‐resistant strains of Helicobacter pylori

Systematic review with meta‐analysis: Vonoprazan, a potent acid blocker, is superior to proton‐pump inhibitors for eradication of clarithromycin‐resistant strains of Helicobacter pylori

Gut microbiome can be restored without adverse events after Helicobacter pylori eradication therapy in teenagers

Metronidazole for Helicobacter pylori eradication therapy among children and adolescents in Japan: Overcoming controversies and concerns

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