Susceptibility-Guided vs. Empiric Retreatment of Helicobacter pylori Infection After Treatment Failure

Yahav, Jacob; Samra, Zmira; Niv, Yaron; Evans, Charlesnika T.; Passaro, Douglas J.; Dinari, Gabriel; Shmuely, Haim

doi:10.1007/s10620-006-9302-2

Cited by 28 publications

(42 citation statements)

References 27 publications

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“…Fiorini and colleagues reported mild-tomoderate side effects in 15% and 20% of patients in each treatment arm; however, all patients complied with at least 90% of the treatment [Fiorini et al 2013]. Gasbarrini and colleagues, Tay and coworkers and Yahav's group did not mention the number of patients with adverse events, though the latter author reported a treatment compliance of 97% [Gasbarrini et al 2000;Tay et al 2012;Yahav et al 2006].…”

Section: Safety and Side Effectsmentioning

confidence: 99%

Systematic review: third-line susceptibility-guided treatment for Helicobacter pylori infection

Puig

López-Góngora

Calvet

et al. 2016

Therap Adv Gastroenterol

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Background: Susceptibility-guided therapies (SGTs) have been proposed as preferable to empirical rescue treatments after two treatment failures. The aim of this study was to perform a systematic review and meta-analysis evaluating the effectiveness and efficacy of SGT as third-line therapy. Methods: A systematic search was performed in multiple databases. Studies reporting cure rates of Helicobacter pylori with SGT in third-line therapy were selected. A qualitative analysis describing the current evidence and a pooled mean analysis summarizing the cure rates of SGT in third-line therapy was performed. Results: No randomized controlled trials or comparative studies were found. Four observational studies reported cure rates with SGT in third-line treatment, and three studies which mixed patients with second-and third-line treatment also reported cure rates with SGT. The majority of the studies included the patients when culture had been already obtained, and so the effectiveness of SGT and empirical therapy has never been compared. A pooled mean analysis including four observational studies (283 patients) showed intention-to-treat and perprotocol eradication rates with SGT of 72% (95% confidence interval 56-87%; I 2 : 92%) and 80% (95% confidence interval 71-90%; I 2 : 80%), respectively. Conclusions: SGT may be an acceptable option as rescue treatment. However, cure rates are, at best, moderate and this approach has never been compared with a well-devised empirical therapy. The evidence in favor of SGT as rescue therapy is currently insufficient to recommend its use.

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Section: Safety and Side Effectsmentioning

confidence: 99%

Systematic review: third-line susceptibility-guided treatment for Helicobacter pylori infection

Puig

López-Góngora

Calvet

et al. 2016

Therap Adv Gastroenterol

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“…Figure 1 details the procedure of study selection in the flow chart. Thirteen studies [13][14][15][16][17][18][19][20][21][22][23][24][25] were qualified in this meta-analysis. Tables 1 and 2 set 2 different control groups, respectively, which were labeled as group a and b in our study (e.g., Lee a and Lee b).…”

Section: Statistical Analysesmentioning

confidence: 99%

“…Ten tailored regimens [14][15][16][17]19,[21][22][23][24][25] were designed according to pretreatment susceptibility testing (pooled RR ¼ 1.17, 95% CI 1.11-1.24). Three other studies 13,18,20 advanced their susceptibility-guided therapy by additionally adjusting their PPI administration (either by dosage adjustments or by changing drugs) on the basis of CYP2C19 polymorphism (pooled RR ¼ 1.14, 95% CI 1.01-1.28).…”

Section: Types Of Tailored Regimensmentioning

confidence: 99%

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318 Tailored Therapy Versus Empiric Chosen Treatment for Helicobacter pylori Eradication: A Meta-Analysis

Chen¹,

Dang²,

Zhou³

et al. 2016

Gastroenterology

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“…Some authors have evaluated the efficacy of susceptibilityguided vs empiric retreatment for H pylori after a treatment failure. In the study by Yahav et al [34] , patients in whom at least one treatment regimen for H pylori eradication had failed underwent gastric biopsy and culture, and were retreated according to the in vitro susceptibility results. Findings were compared with those of control patients (where culture was unavailable).…”

Section: Is It Necessary To Perform Culture After Failure Of the Firsmentioning

confidence: 99%

“Rescue” regimens after Helicobacter pylori treatment failure

Gisbert¹

2008

WJG

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Helicobacter pylori (H pylori ) infection is the main cause of gastritis, gastroduodenal ulcer disease, and gastric cancer. After more than 20 years of experience in H pylori treatment, in my opinion, the ideal regimen to treat this infection is still to be found. Currently, apart from having to know first-line eradication regimens well, 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 clarithromycinbased regimen was used initially, a subsequent metronidazole-based treatment (quadruple therapy) may be used afterwards, and then a levofloxacinbased combination would be a third "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, a quadruple regimen may be reserved as a third-line rescue option. Finally, rifabutin-based rescue therapy constitutes an encouraging empirical fourthline 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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Susceptibility-Guided vs. Empiric Retreatment of Helicobacter pylori Infection After Treatment Failure

Cited by 28 publications

References 27 publications

Systematic review: third-line susceptibility-guided treatment for Helicobacter pylori infection

Systematic review: third-line susceptibility-guided treatment for Helicobacter pylori infection

318 Tailored Therapy Versus Empiric Chosen Treatment for Helicobacter pylori Eradication: A Meta-Analysis

“Rescue” regimens after Helicobacter pylori treatment failure

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