Standard triple therapy forHelicobacter pyloriinfection in China: A meta-analysis

Wang, Ben; Lv, Zhifa; Wang, Youhua; Wang, Hui; Liu, Xiaoqun; Xie, Yong; Zhou, Xiaojiang

doi:10.3748/wjg.v20.i40.14973

Cited by 42 publications

(41 citation statements)

References 56 publications

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“…Standard triple therapy (STT), including a proton‐pump inhibitor (PPI) and two antimicrobial agents, has been recommended as the standard first‐line eradication therapy since 1996 . However, most recent data show that this combination has lost efficacy, and its cure rates declined to <80% in most Asia‐Pacific countries due to high clarithromycin (CLA) resistance . With the efficacy of the H pylori triple treatment decreasing, some novel alternatives have been developed, such as bismuth‐containing quadruple therapy and non‐bismuth‐containing quadruple therapy (sequential treatment and concomitant treatment).…”

Section: Introductionmentioning

confidence: 99%

Comparison of four different regimens against Helicobacter pylori as a first‐line treatment: A prospective, cross‐sectional, comparative, open trial in Chinese children

et al. 2020

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Backgrounds Due to the decreasing eradication rate of Helicobacter pylori, some novel alternatives have been developed, such as bismuth‐containing quadruple therapy and non‐bismuth‐containing quadruple therapy (sequential and concomitant treatment). Little is known about whether a success rate above 90% can be achieved with these regimens in Chinese children. Methods In this prospective, open, comparative cross‐sectional study, we recruited treatment‐naïve children (aged between 6 and 18 years) with H pylori infection. The patients were assigned either standard triple therapy, sequential therapy, bismuth‐based quadruple therapy, or concomitant therapy at the discretion of the prescribing physician. H pylori infection was evaluated at least 4 weeks after the completion of the treatment. A negative urea breath test (UBT) indicated successful eradication. The primary endpoint was the eradication frequency of H pylori in the full analysis set (FAS), which included all children who received at least one dose of the treatment and with available follow‐up data. Results Between September 2017 and December 2018, 228 patients were finally included in the FAS analyses. The eradication rates were 74.1% for standard triple therapy (43/58, [95% CI: 62.8%‐85.5%]), 69.5% for sequential therapy (41/59, [95% CI: 57.8%‐81.2%]), 89.8% for bismuth‐based quadruple therapy (53/59, [95% CI: 82.1%‐97.5%]), and 84.6% for concomitant therapy (44/52, [95% CI: 74.8%‐94.4%]). Bismuth‐based therapy was superior to triple therapy, while sequential therapy and concomitant therapy were not superior to triple therapy. The frequency of adverse events was 12.1% (7/58) in standard triple therapy, 6.8% (4/59) in sequential therapy, 15.3% (9/59) in bismuth‐based therapy, and 15.4% (8/52) in concomitant therapy. The rate of adverse events was similar among the four groups. Conclusion Bismuth quadruple therapy can achieve an eradication rate of 89.8% as first‐line treatment and is safe and well tolerated. Bismuth could be a promising alternative as a first‐line regimen in Chinese children.

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Section: Introductionmentioning

confidence: 99%

Comparison of four different regimens against Helicobacter pylori as a first‐line treatment: A prospective, cross‐sectional, comparative, open trial in Chinese children

et al. 2020

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“…Previously, standard triple therapy, a proton‐pump inhibitor (PPI) in combination with typically two antibiotics (amoxicillin and clarithromycin), was recommended as first‐line treatment by the guideline for many years . However, in recent years, with the widespread and inappropriate use of antibiotics, the antibiotics resistance has been increasing, and the eradication rate of standard triple therapy has been far below the acceptable level according to professor Graham's grading report card on H pylori therapy . Moreover, the combination use of multiple antibiotics may result in a series of adverse effects, such as diarrhea, nausea, and vomiting, which can reduce the compliance of patients to some extent, and thereby leading to a reduction in H pylori eradication rates …”

Section: Introductionmentioning

confidence: 99%

Saccharomyces boulardii as an adjuvant therapy for Helicobacter pylori eradication: A systematic review and meta‐analysis with trial sequential analysis

Zhou

Chen

et al. 2019

Helicobacter

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Background and Aims: Whether Saccharomyces boulardii (S boulardii) as an adjuvant therapy are beneficial to H pylori eradication remains controversial. The aim of the study was to update and determine the effects of S boulardii as an adjuvant therapy on H pylori eradication rates and adverse effects. Methods: We searched PubMed, Embase, CENTRAL, and Web of Science to collect all randomized controlled trials assessing the effects of S boulardii as an adjuvant therapy for H pylori eradication from inception to February 2019. Quality of evidence was appraised using Grading of Recommendations, Assessment, Development and Evaluation system. Trial sequential analysis was performed to control the risk of type I and type II errors.Results: Eighteen trials with 3592 patients were eligible for meta-analysis. Compared with standard eradication regimen, the S boulardii supplementation could significantly improve eradication rates [risk ratio (RR) = 1.09, 95% confidence interval (CI):1.05-1.13; moderate quality evidence] and reduce the incidence of total side effects (RR = 0.47, 95%CI:0.36-0.61; low quality evidence), as well as some gastrointestinal adverse effects, especially diarrhea (RR = 0.33, 95%CI:0.23-0.47; low quality evidence) and constipation (RR = 0.37, 95%CI:0.23-0.57; moderate quality evidence).In addition, the need for discontinuation rate in S boulardii supplementation group was significantly lower than in the control group (RR = 0.33, 95%CI:0.16-0.69, P = .003; moderate quality evidence). The TSA results for overall eradication rates and total side effects indicated that the effects were conclusive. Conclusions:Our meta-analysis shows that S boulardii supplementation on standard eradication therapy significantly increased H pylori eradication rates and reduced the incidence of total side effects and some gastrointestinal adverse effects during eradication therapy. K E Y W O R D SHelicobacter pylori, meta-analysis, Saccharomyces boulardii, trial sequential analysis 2 of 16 | ZHOU et al.

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“…H. pylori infections are treated with different antimicrobials such as clarithromycin, metronidazole, amoxicillin, tetracycline, ciprofloxacin, levofloxacin, moxifloxacin, azithromycin, erythromycin, furazolidone, and nitrofurantoin [2][3][4][5], which are combined with a proton pump inhibitor (PPI) to increase their absorption in the stomach of the patient [5,6]. In Colombia, infection eradication therapy is empirical, in which the first-line treatment is the clarithromycin-based standard triple therapy (clarithromycin, amoxicillin and PPIs), agreeing to national and international guidelines [7][8][9]. Resistance rates have increased in many countries, which warrant a continuous study of the H. pylori resistance rates worldwide and regionally [6].…”

Section: Introductionmentioning

confidence: 99%

Surveillance of the Antimicrobial Resistance Rates of Helicobacter pylori Ten Years Later in the Western Central Region, Colombia

Bedoya-Gómez

Aldana

Moncayo

et al. 2019

Dig Dis

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Background: Helicobacter pylori is a bacterium associated with gastroduodenal disease and gastric cancer. Empirical therapy in the treatment of H. pylori infection increases the risk of apparition of antimicrobial drug resistance. In a previous report, in H. pylori clinical isolates, resistance rates to commonly used antimicrobial drugs were as follows: metronidazole 82%, clarithromycin 3.8%, and amoxicillin 1.9%. The aim was to establish the variation of resistance rates and the detection of H. pylori genetic mutations isolated from dyspeptic patients. Methods: Antimicrobial susceptibility profiles were performed by the E-test method for metronidazole, clarithromycin, amoxicillin, and tetracycline in 61 clini-cal isolates. Sequencing was performed to detect mutations associated with resistance to clarithromycin. Results: According to our results, resistance rates found in the 61 isolates were 78.60% for metronidazole and 8.20% for clarithromycin. None of the studied isolates had resistance to tetracycline and amoxicillin. Secondary resistance rates displayed an increase when compared to primary rates for metronidazole (87.50 vs. 77.35%) and for clarithromycin (25.66 vs. 5.66%). Of 5 isolates resistant to clarithromycin, 3 had the A2143G mutation. By comparing the results in this work with previous reports, antimicrobial drug resistance rates did not show major modifications for metronidazole, amoxicillin, and tetracycline during the last 10 years. For clarithromycin, the resistance rate showed a moderate increase; nevertheless, it remains low (< 15%) and this change was not statistically significant. Conclusion: Together, all findings in this work indicate that these antimicrobial drugs can still be used as first line of defense on infected patients living in this region of the country.

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Standard triple therapy forHelicobacter pyloriinfection in China: A meta-analysis

Abstract: The eradication rates with a standard triple therapy consisting of PPI, AMO, and CLA are suboptimal in China, and new treatment agents need to be developed.

Cited by 42 publications

References 56 publications

Comparison of four different regimens against Helicobacter pylori as a first‐line treatment: A prospective, cross‐sectional, comparative, open trial in Chinese children

Comparison of four different regimens against Helicobacter pylori as a first‐line treatment: A prospective, cross‐sectional, comparative, open trial in Chinese children

Saccharomyces boulardii as an adjuvant therapy for Helicobacter pylori eradication: A systematic review and meta‐analysis with trial sequential analysis

Surveillance of the Antimicrobial Resistance Rates of <b><i>Helicobacter pylori</i></b> Ten Years Later in the Western Central Region, Colombia

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