Second-line treatment for Helicobacter pylori infection in Japan: proton pump inhibitor-based amoxicillin and metronidazole regimen

Nagahara, Akihito; Miwa, Hiroto; Kawabe, Masato; Kurosawa, Akihiko; Asaoka, Daisuke; Hojo, Mariko; Iijima, Katsuyori; Terai, Takeshi; Ohkusa, Toshifumi; Miyazaki, Akira; Sato, Nobuhiro

doi:10.1007/s00535-004-1443-5

Cited by 22 publications

(17 citation statements)

References 24 publications

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“…As for the second-line therapy after failure of the first-line therapy, eradication rates over 90% were achieved (fig. 3b), which is consistent with other reports [25,26,27,28,29,30]. …”

Section: Resultssupporting

confidence: 83%

“…However, a gradual decline in the eradication rate with this regimen (<80%) has been reported due to the spread of CAM resistance in Japan [22,23,24]; a second-line therapy using MNZ in place of CAM was approved in 2007. Excellent eradication rates achieving more than 90% success were reported with these regimens (table 2) [25,26,27,28,29,30]. A major reason for this high efficiency may be ascribed to the low MNZ resistance in Japan [23,24].…”

Section: Resultsmentioning

confidence: 94%

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Clinical Management of Helicobacter pylori - The Japanese Perspective

Sugano

Osawa

Satoh

2014

Dig Dis

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Background: After the approval of health insurance coverage of eradication therapy for Helicobacter pylori-positive peptic ulcer disease (PUD) in 2000, comprehensive coverage for H. pylori infection itself was implemented in 2013. Methods: We did a literature search using PubMed database on the management of H. pylori infection including indications, regimens, outcomes of current eradication therapies, trends of antibiotic resistance rates and proposed third-line rescue therapy in Japan. We also collected data on changes of eradication rates in our hospital by searching electronic medical records. Results: After implementation of insurance coverage of eradication therapy for PUD, dramatic reduction of the number patients with PUD as well as spending on ulcer drug was documented. According to the current regulation, proton pump inhibitor (PPI)-based triple therapy with 2 antibiotics, amoxicillin (AMPC) plus clarithromycin, for 7 days is approved as the first-line therapy. After failure of the first-line therapy, PPI plus AMPC and metronidazole is authorized as the second line, which maintains an excellent eradication rate of over 90% in Japan. When these two therapies fail, a sitafloxacin-based therapy seems to be most promising among many rescue regimens. Conclusion: Comprehensive public health insurance coverage of H. pylori infection will promote eradication in Japanese people infected with H. pylori, whose risk of developing gastric cancer has been shown to be high. It also provides us a unique opportunity to study whether the broader indications can accelerate the reduction of gastric cancer in Japan in the same way we witnessed the reduction of PUD.

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“…As for the second-line therapy after failure of the first-line therapy, eradication rates over 90% were achieved (fig. 3b), which is consistent with other reports [25,26,27,28,29,30]. …”

Section: Resultssupporting

confidence: 83%

Section: Resultsmentioning

confidence: 94%

Clinical Management of Helicobacter pylori - The Japanese Perspective

Sugano

Osawa

Satoh

2014

Dig Dis

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“…Indeed, following a trial in France [19•], this combination is currently recommended as a second-line treatment. A recent Japanese study in which metronidazole resistance was almost nonexistent resulted in an eradication rate of 90% to 99% [26]. Longer duration of this treatment increases the success rate, as was shown in an Indian study.…”

Section: Modify the Drug Combinationmentioning

confidence: 87%

Update on therapeutic options for Helicobacter pylori-related diseases

Mégraud

2005

Curr Infect Dis Rep

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Triple therapy including clarithromycin, amoxicillin, and a proton pump inhibitor (PPI) has been recommended as the treatment of choice for Helicobacter pylori eradication. This regimen is now challenged by an increasing level of clarithromycin resistance that jeopardizes the treatment success. When clarithromycin resistance has been detected, or when its rate is known to be high in the geographic area, this drug cannot be used. It can be replaced by metronidazole, the resistance of which has a limited clinical relevance. Another option is to prescribe tetracycline and metronidazole with a PPI or ranitidine bismuth citrate. New antibiotics such as levofloxacin or rifabutin can also be used in combination with amoxicillin and a PPI. Probiotics can be added to all of these regimens to improve compliance by decreasing adverse events. But some authors advocate a quadruple therapy as a first-line treatment. Solutions to improve the limitations of this last regimen are now being proposed. Clarification of the controversial treatment indications such as gastroesophageal reflux disease or prevention of nonsteroidal anti-inflammatory drug gastroduodenal symptoms has been made. The question of prevention of gastric carcinoma by H. pylori eradication remains unanswered.

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“…In the changing scenario of increased resistance rate to clarithromycin, these treatments are increasingly adopted as first options. A triple therapy consisting of amoxicillin 1000 mg twice daily, metronidazole 500 mg twice daily and PPI at double doses has been proposed [45,46]. Recent data, however, show cure rates lower than 80% with this treatment [47].…”

Section: Non Clarithromycin Based Regimensmentioning

confidence: 97%

Recent Advances in the Treatment of Helicobacter pylori Infection

Bergamaschi

Magrini²,

Pietroiusti³

2007

PRI

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The approach to the treatment of Helicobacter pylori infection has changed during the last years. In fact, during the last decade, the success rate of usual eradication regimens, based on a proton pump inhibitor plus clarithromycin associated with amoxicillin or metronidazole, declined from over 90% to about 80%, a critical threshold under which the eradication rate is considered unsatisfactory, according to current guidelines. This finding is mainly due to the raising prevalence of clarithromycin resistance, which is in turn linked to the widespread use of this antibiotic for respiratory tract infections. Therefore, obtaining a personal history negative for a previous use of macrolides is now mandatory, before administering clarithromycin-based antibiotic therapy. Should history data be uncertain, local resistance rates (if available) may be considered, with levels higher than 20% precluding the use of clarithromycin. In this case, alternative antibiotic combinations, previously used in the rare instances of failure of clarithromycin-based therapy, should be used. We examined also the possible additional beneficial effect of some novel non antibiotic agents such as lactoferrin, probiotics and natural substances. Other advances in the treatment of the infection are represented by the discovery that some extragastric disorders such as unexplained iron deficiency anemia and idiopathic thrombocytopenic purpura, may be causally linked to Helicobacter pylori, and that eradication therapy may lead to their regression in many cases. Finally, some "gray areas" (nonulcer dyspepsia, concomitant use of nonsteroidal anti-inflammatory drugs) which are the subject of debate as far the indication to treatment is concerned, have been discussed.

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Second-line treatment for Helicobacter pylori infection in Japan: proton pump inhibitor-based amoxicillin and metronidazole regimen

Abstract: The 10-day PPI/AM re-treatment regimen is safe and effective, suggesting its usefulness as second-line treatment in Japan in patients who have failed initial treatment with the PPI/AC regimen.

Cited by 22 publications

References 24 publications

Clinical Management of <b><i>Helicobacter pylori</i></b> - The Japanese Perspective

Clinical Management of <b><i>Helicobacter pylori</i></b> - The Japanese Perspective

Update on therapeutic options for Helicobacter pylori-related diseases

Recent Advances in the Treatment of Helicobacter pylori Infection

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