Systematic review and meta-analysis: full- vs. half-dose anti-microbials in clarithromycin-based regimens for<i>Helicobacter pylori</i>eradication

Harb, Ali H.; Chalhoub, Jean M.; Mrad, Rachel Abou; Sharara, Ala I.

doi:10.1111/apt.13259

Cited by 12 publications

(13 citation statements)

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“…In one meta-analysis, researchers assessed efficacy of full-and half-dose clarithromycin-based triple therapy and suggested to use half-dose clarithromycin for the treatment of H.pylori infection infections. 18 In another prospective randomized trial, researchers reduced the dosage of all druges (rabeprazole, amoxicillin, clarithromycin, and metronidazole) by 50%, and achieved a similar conclusion. 19 Moreover, a research based on patients with end-stage renal disease also showed that a 50% reduction in clarithromycin did not diminish the treatment efficacy (74% vs 74%).…”

Section: Introductionmentioning

confidence: 89%

“…The optimal dose of clarithromycin for Asian may be different. In one meta‐analysis, researchers assessed efficacy of full‐ and half‐dose clarithromycin‐based triple therapy and suggested to use half‐dose clarithromycin for the treatment of H.pylori infection infections . In another prospective randomized trial, researchers reduced the dosage of all druges (rabeprazole, amoxicillin, clarithromycin, and metronidazole) by 50%, and achieved a similar conclusion .…”

Section: Introductionmentioning

confidence: 99%

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Half‐dose clarithromycin‐containing bismuth quadruple therapy is effective and economical in treating Helicobacter pylori infection: A single‐center, open‐label, randomized trial

Wang

et al. 2019

Helicobacter

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Background Clarithromycin‐containing bismuth quadruple therapy has been recommended as the first‐line therapy for H pylori infection in China. However, its expensive cost and high antibiotic‐related adverse reactions are always haunting us. To find a safer, more cost‐effective, and high eradicative strategy for Helicobacter treatment, we investigated the efficacy of 14‐day bismuth quadruple therapy and different doses of clarithromycin in the first‐line treatment. Method A total of 210 patients with H pylori infection were recruited and randomly assigned to half‐dose clarithromycin group (esomeprazole 20 mg bid, amoxicillin 1 g bid, clarithromycin 250 mg bid, and bismuth potassium citrate 0.6 g bid) for 14 days or standard‐dose clarithromycin group (esomeprazole 20 mg bid, amoxicillin 1 g bid, clarithromycin 500 mg bid, and bismuth potassium citrate 0.6 g bid) for 14 days. A 13C‐urea breath test (13C‐UBT) was performed at least 4 weeks after treatment. The eradication rate of H pylori, the incidence of side effects, and the cost‐effectiveness of regimens were evaluated in this study. Results The eradication frequencies were 86.67% for both groups in the intention‐to‐treat analysis, while the per‐protocol eradication rates were 91% vs. 91.92% (p=0.817). The incidence of adverse events was higher in standard dose group (54.21% vs. 34.29%; p=0.004), especially bitter taste symptom. There was a higher level of costs per person associated with the standard‐dose group as compared with half‐dose group (￥804.3 vs ￥654.36). The cost‐effectiveness ratio of the half dose was less than that of the standard dose (7.55 vs 9.16 CNY per percent). Conclusions A 14‐day half‐dose clarithromycin‐containing bismuth quadruple regimen is as effective as the standard bismuth quadruple therapy at eradicating H pylori, which is better tolerated and more economical. (ChiCTR‐ROC‐15007406).

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Section: Introductionmentioning

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Half‐dose clarithromycin‐containing bismuth quadruple therapy is effective and economical in treating Helicobacter pylori infection: A single‐center, open‐label, randomized trial

Wang

et al. 2019

Helicobacter

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“…Pharmacokinetic changes associated with advanced age, such as reduced renal function, may predispose this population to higher antibiotic serum concentrations and subsequent treatment‐related adverse reactions . Consequently, clarithromycin and fluoroquinolone doses should be reduced in patients with significant renal impairment to avoid the increased risk of adverse effects such as gastrointestinal upset and central nervous system effects, respectively . In a single‐center study of 154 patients older than 60 years with H. pylori infection, patients were randomized to receive clarithromycin triple therapy with either clarithromycin 250 mg twice/day or 500 mg twice/day .…”

Section: Elderlymentioning

confidence: 99%

“…75,76 Consequently, clarithromycin and fluoroquinolone doses should be reduced in patients with significant renal impairment to avoid the increased risk of adverse effects such as gastrointestinal upset and central nervous system effects, respectively. 77,78 In a single-center study of 154 patients older than 60 years with H. pylori infection, patients were randomized to receive clarithromycin triple therapy with either clarithromycin 250 mg twice/day or 500 mg twice/ day. 69 Numerically more patients receiving the higher clarithromycin dose reported having adverse events (9% vs 5%, p value not significant).…”

Section: Elderlymentioning

confidence: 99%

Treatment of Helicobacter pylori in Special Patient Populations

et al. 2019

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Helicobacter pylori infection can lead to gastritis, gastric and duodenal ulcers, and gastric cancer. Consequently, complete eradication is the goal of therapy. First‐line therapy for H. pylori infection includes clarithromycin triple therapy (clarithromycin, proton pump inhibitor [PPI], and amoxicillin or metronidazole), bismuth quadruple therapy (bismuth salt, PPI, tetracycline, and metronidazole or amoxicillin), or concomitant therapy (clarithromycin, PPI, amoxicillin, and metronidazole). However, many patients have relative contraindications to the antibiotics included in these regimens, making therapy selection difficult. Furthermore, failure of initial therapy makes selection of second‐line therapy challenging due to concerns for potential resistance to agents included in the initial regimen. This review discusses H. pylori microbiology, including antibiotic resistance, and summarizes the existing evidence for first‐ and second‐line treatment regimens that may be considered for special populations such as patients with penicillin allergies, patients with or at risk for QTc‐interval prolongation, and patients who are pregnant, breastfeeding, or elderly.

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“…Helicobacter pylori infection is associated with chronic gastritis, peptic ulcer disease, gastric adenocarcinoma, and non‐Hodgkin's mucosa‐associated lymphoid tissue (MALT) lymphoma of the stomach . East Asian countries with a high incidence of gastric cancer, such as Korea and Japan, have been making efforts to eliminate H. pylori to prevent gastric cancer .…”

Section: Introductionmentioning

confidence: 99%

Online registry for nationwide database of Helicobacter pylori eradication in Korea: Correlation of antibiotic use density with eradication success

et al. 2019

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Background The Helicobacter pylori eradication rate has decreased with increasing antibiotic resistance. We conducted a prospective, nationwide, multicenter registry study to monitor the real status of H. pylori eradication therapy and to investigate the association between eradication success and antibiotic use density in Korea. Materials and Methods We enrolled 9318 patients undergoing H. pylori eradication therapy from 37 hospitals through “on‐line database registry” from October 2010 to July 2015. Demographic data, detection methods, treatment indications, regimens, durations, compliance, adverse events, and eradication results were collected. The use of all commercially available eradication antibiotics was analyzed through the Korean National Health Insurance data of the Health Insurance Review and Assessment Service. The defined daily dose of antibiotics was used to standardize drug use comparisons. Results Finally, 6738 patients were analyzed. The overall eradication rate of first‐line therapy was 71.8%. The eradication success rates were 71.7%, 86.9%, and 74.0% for standard triple therapy for 7 days, quadruple therapy, and concomitant therapy, respectively. The eradication success rate in naive patients was higher than that in those who previously underwent H. pylori eradication. Eradication success was significantly associated with younger age, female sex, and high compliance. Regional differences in eradication rates were observed. The yearly use density of clarithromycin increased statistically in seven regions across the country from 2010 to 2015. The yearly use density of amoxicillin in the Gyeongsang and Chungcheong areas was significantly increased (P < .01), whereas that of other macrolides was significantly lower in the Gyeonggi area than in other areas (P = .01). The overall use of eradication antibiotics has increased while the eradication rate steadily decreased for 5 years. However, there was no significant correlation between antibiotic use density and eradication. Conclusion There was no relationship between the eradication rate and antibiotic use density in Korea.

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Systematic review and meta-analysis: full- vs. half-dose anti-microbials in clarithromycin-based regimens forHelicobacter pylorieradication

Abstract: SUMMARY BackgroundHalf-dose regimens may be equally effective but associated with diminished adverse events (AE) than standard-dose regimens.

Cited by 12 publications

References 51 publications

Half‐dose clarithromycin‐containing bismuth quadruple therapy is effective and economical in treating Helicobacter pylori infection: A single‐center, open‐label, randomized trial

Half‐dose clarithromycin‐containing bismuth quadruple therapy is effective and economical in treating Helicobacter pylori infection: A single‐center, open‐label, randomized trial

Treatment of Helicobacter pylori in Special Patient Populations

Online registry for nationwide database of Helicobacter pylori eradication in Korea: Correlation of antibiotic use density with eradication success

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