The HOMER Study: The Effect of Increasing the Dose of Metronidazole When Given with Omeprazole and Amoxicillin to Cure Helicobacter pylori Infection

Bardhan, Karna Dev; Bayerdörffer, Ekkehard; Zanten, S. J. O. Veldhuyzen Van; Lind, Tore; Mégraud, Françis; Delchier, Jean Charles; Hellblom, M; Stubberöd, A; Burman, Carl‐Fredrik; Gromark, Per‐Olof; Zeijlon, L.

doi:10.1046/j.1523-5378.2000.00030.x

Cited by 73 publications

(75 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The results of different combinations of dual therapy such as a PPI plus amoxicillin, plus clarithromycin, plus metronidazole were established long ago as well as differences that can be expected by changes in dose and duration of these combinations 13,[52][53][54][55][56] . Generally, the results of therapy in the face of specific antimicrobial resistance mirror what would be expected based on loss of the antibiotic from the combination.…”

Section: Predicting the Effect Of Resistance On Treatment Successmentioning

confidence: 99%

New concepts of resistance in the treatment of Helicobacter pylori infections

Graham

Shiotani

2008

Nat Rev Gastroenterol Hepatol

316

368

View full text Add to dashboard Cite

SummaryThe prevalence of antimicrobial resistance is now such that all patients should be considered as having resistant infections. Ideally therapy is based on pretreatment susceptibility testing. Empiric therapies should assume antimicrobial resistance and use higher doses for 14 days. Acceptable results are 90-94% cure intention to treat (Grade B) or greater. Clarithromycin-containing triple therapies now typically produce ≤80% cure ITT (Grade F) and are no longer acceptable empiric therapy. Current initial therapy options are between sequential therapy, concomitant therapy, and bismuth containing quadruple therapy. Sequential therapy has the potential to be improved to ≥95% cure ITT (Grade A) by continuing the amoxicillin through the second and/or by increasing the duration. Better appreciation of the role of acidity in phenotypic resistance has resulted in high cure rates with high dose PPI plus amoxicillin dual therapy; additional studies to devise better dual-based multidrug regimes are still needed. Antimicrobial choices following treatment failure is best approached by susceptibility testing. If not available, we recommended a bismuth containing quadruple therapy substituting a new drug for metronidazole/tinidazole and/or clarithromycin if they have been used previously. The alternate would be to use a 14 day high dose PPI, amoxicillin-based triple therapy with rifabutin, a fluoroquinolone, or furazolidone. KeywordsHelicobacter pylori; therapy; resistance; antibiotics; anti-secretory drugs; phenotypic drug resistance; cytochrome P450 "To read without reflecting is like eating without digesting". -86-462-1111-86-462- , FAX 81-86-464-1195 Review criteria: We searched the relevant papers by using computer-assisted bibliographic searches of PubMed through November 30, 2007 using combinations of the following terms: H. pylori combined with resistance, therapy, eradication, second, triple, quadruple, sequential, or rescue. We also reviewed the recent literature on pharmacokinetics and pharmacodynamics in relation to the drugs used in H. pylori therapy and the relation to host cytochrome P450 genotypes to treatment outcome. We did not perform meta-analyses. We reviewed only articles published in English.

show abstract

Section: Predicting the Effect Of Resistance On Treatment Successmentioning

confidence: 99%

New concepts of resistance in the treatment of Helicobacter pylori infections

Graham

Shiotani

2008

Nat Rev Gastroenterol Hepatol

316

368

View full text Add to dashboard Cite

show abstract

“…In the HOMER study, 57% of subjects with baseline resistance to MET successfully eradicated the organism with amoxicillin, MET and omeprazole taken for 1 week. When a high dose of MET was given (800 mg twice a day), eradication was achieved in 75% of the MET-resistant patients [20]. In this context, the clinical relevance of in vitro MET resistance in our study may be questioned.…”

Section: Discussionmentioning

confidence: 83%

“…Another issue which may affect interpretation of our results is the fact that nitroimidazole resistance is relative and may be partially overcome by increasing the dosage [20]. Therefore, subjects with documented MET resistance may still, theoretically, achieve eradication with this drug.…”

Section: Discussionmentioning

confidence: 99%

Appropriateness of Repeating Helicobacter pylori Culture and Susceptibility Testing Following Failure of Individualized Antibiotic Therapy

et al. 2015

View full text Add to dashboard Cite

Background: Current guidelines recommend direct Helicobacter pylori culture and antibiotic susceptibility testing following 2 failed eradication attempts. If this process is followed and yet subsequent treatment is unsuccessful, it is unclear whether susceptibility testing should be repeated. This is the first study to examine the appropriateness of repeated H. pylori culture and susceptibility testing following failure of individualized treatment. Methods: Between 2007 and 2014, consecutive patients who underwent at least 2 upper gastrointestinal endoscopies with H. pylori culture and susceptibility testing at our institution following several treatment failures were retrospectively identified. Antibiotic susceptibility was recorded and linked to demographic data. Results: A total of 68 cultures from 34 patients were included (12 (35.3%) men, 41.4 ± 16.6 years), and 20 (58.8%) cultures had a different antibiotic susceptibility profile on repeat testing (8 (23.5%) with new susceptibility and 13 (38.2%) with new resistance). Acquired resistance to clarithromycin, levofloxacin and metronidazole was observed in 9 (26.5%), 2 (5.9%) and 10 (29.4%) cultures, respectively. Subjects with resistance to ≤1 antibiotic at baseline were more likely to develop resistance to at least 1 antibiotic on subsequent culture, compared to subjects with resistance to ≥2 antibiotics at baseline (13 (100%) vs. 5 (23.8%), p < 0.01). Conclusion: Repeating H. pylori culture and susceptibility testing usually yields new antimicrobial susceptibility data. However, the clinical usefulness of this approach remains unclear.

show abstract

“…Similar results were also obtained in patients harboring metronidazole-resistant strains [74][75][76] . European trials, using doses of metronidazole higher than those employed in Japanese studies, confi rmed the sa tisfactory eradication rate with this treatment for 7-14 days, although the effi cacy dropped to about 60% in presence of metronidazole-resistant strains [77][78][79] . Furthermore, a French randomized open study compared the Table 3.…”

Section: Treatment Options For Nonresponders To First-line Treatment mentioning

confidence: 85%

‘Rescue’ Therapies for the Management of Helicobacter pylori Infection

Mario¹,

Cavallaro²,

Scarpignato

2006

Dig Dis

View full text Add to dashboard Cite

Helicobacter pylori infection is the main cause of gastritis, gastroduodenal ulcer and gastric cancer and should be considered as a major public health issue. According to several international guidelines, first-line therapy for treating H. pylori infection consists of proton pump inhibitor (PPI) or ranitidine bismuth citrate (RBC) with any two antibiotics of amoxicillin, clarithromycin or metronidazole given for 7–14 days. However, even with the recommended treatment regimens, approximately 20% of patients will fail to obtain H. pylori eradication. The proportion of patients with first-line H. pylori therapy failure may be higher in clinical practice and it may increase thanks to diffusion of H. pylori treatment. The recommended second-line therapy is the quadruple regimen composed by tetracycline, metronidazole, bismuth salts and a PPI. However, the efficacy of this regimen is limited by poor patient’s compliance due to its side effects, number of tablets per day, and long duration. Moreover, bismuth and metronidazole are not available in all countries. Alternatively, a longer-lasting (i.e. 10–14 days) PPI or RBC triple therapy with two antibiotics has generally been used. In an empirical strategy, the choice of second line depends on the treatment initially used. If a clarithromycin-based regimen was administered in first line, a quadruple regimen or PPI (or RBC) triple therapy with metronidazole and amoxicillin (or tetracycline) should be suggested as a second line. In case of second-line treatment failure, the patient should be evaluated by a case-by-case approach. A susceptibility-guided strategy, if available, is recommended in order to choose the best third-line treatment. Culture can reveal the presence of H. pylori-sensitive strains to clarithromycin (the best effective) or other antimicrobials (such as amoxicillin, metronidazole and tetracycline). Conversely, in an empirical strategy, a third-line not yet used therapy, can reach a high success rate. PPI or RBC, amoxicillin and a new antimicrobial (e.g. rifabutin, levofloxacin or furazolidone) could be used. Several studies have obtained relatively good results with triple therapy combining PPI, rifabutin, and amoxicillin, although a reversible myelotoxicity as leukopenia and thrombocytopenia has been described. Preliminary good results were also achieved with triples PPI regimens combining levofloxacin and amoxicillin without important adverse effects. Furazolidone has also shown efficacy for H. pylori eradication, although untoward reactions could limit its use, especially when high doses are employed. Finally, in more than one H. pylori treatment failure, non-antimicrobial add-on medications (such as lactoferrin, probiotics and others) could be used with the aim either to improve the eradication rate or to minimize side effects.

show abstract

The HOMER Study: The Effect of Increasing the Dose of Metronidazole When Given with Omeprazole and Amoxicillin to Cure Helicobacter pylori Infection

Cited by 73 publications

References 13 publications

New concepts of resistance in the treatment of Helicobacter pylori infections

New concepts of resistance in the treatment of Helicobacter pylori infections

Appropriateness of Repeating <b><i>Helicobacter pylori</i></b> Culture and Susceptibility Testing Following Failure of Individualized Antibiotic Therapy

‘Rescue’ Therapies for the Management of <i>Helicobacter pylori </i>Infection

Contact Info

Product

Resources

About