scholarly journals Rescue Therapy forHelicobacter pyloriInfection 2012

2012 ◽  
Vol 2012 ◽  
pp. 1-12 ◽  
Author(s):  
Javier P. Gisbert
Keyword(s):  
Rescue Therapy ◽  
Gastroduodenal Ulcer ◽  
Primary Therapy ◽  
First Line ◽  
Quadruple Therapy ◽  
Ulcer Disease ◽  
Rescue Treatment ◽  
Third Line ◽  
H Pylori ◽  
Almost All

Helicobacter pyloriinfection is the main cause of gastritis, gastroduodenal ulcer disease, and gastric cancer. After 30 years of experience inH. pyloritreatment, however, the ideal regimen to treat this infection has still to be found. Nowadays, apart from having to know well first-line eradication regimens, we must also be prepared to face treatment failures. In designing a treatment strategy, we should not only 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 first-line clarithromycin-based regimen was used, a second-line metronidazole-based treatment (quadruple therapy) may be used afterwards, and then a levofloxacin-based combination would be a third-line “rescue” option. Alternatively, it has recently been suggested that levofloxacin-based “rescue” therapy constitutes an encouraging 2nd-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, quadruple regimen may be reserved as a 3rd-line “rescue” option. Even after two consecutive failures, several studies have demonstrated thatH. pylorieradication can finally be achieved in almost all patients if several “rescue” therapies are consecutively given.

scholarly journals The Optimal First-Line Therapy ofHelicobacter pyloriInfection in Year 2012

2012 ◽  
Vol 2012 ◽  
pp. 1-8 ◽  
Author(s):  
Chao-Hung Kuo ◽  
Fu-Chen Kuo ◽  
Huang-Ming Hu ◽  
Chung-Jung Liu ◽  
Sophie S. W. Wang ◽  
...  
Keyword(s):  
Rescue Therapy ◽  
Treatment Strategies ◽  
Sequential Therapy ◽  
Antibiotics Resistance ◽  
First Line ◽  
First Line Therapy ◽  
Metronidazole Resistance ◽  
Rescue Treatment ◽  
New Treatment ◽  
H Pylori

This paper reviews the literature about first-line therapies forH. pyloriinfection in recent years. First-line therapies are facing a challenge because of increasing treatment failure due to elevated antibiotics resistance. Several new treatment strategies that recently emerged to overcome antibiotic resistance have been surveyed. Alternative first-line therapies include bismuth-containing quadruple therapy, sequential therapy, concomitant therapy, and hybrid therapy. Levofloxacin-based therapy shows impressive efficacy but might be employed as rescue treatment due to rapidly raising resistance. Rifabutin-based therapy is also regarded as a rescue therapy. Several factors including antibiotics resistance, patient compliance, and CYP 2C19 genotypes could influence the outcome. Clinicians should use antibiotics according to local reports. It is recommended that triple therapy should not be used in areas with high clarithromycin resistance or dual clarithromycin and metronidazole resistance.

scholarly journals Optimization Strategies Aimed to Increase the Efficacy of Helicobacter pylori Eradication Therapies with Quinolones

Molecules ◽  
2020 ◽  
Vol 25 (21) ◽  
pp. 5084
Author(s):  
Javier P. Gisbert
Keyword(s):  
Gastroduodenal Ulcer ◽  
Eradication Therapy ◽  
Ulcer Disease ◽  
Simple Alternative ◽  
Third Line ◽  
H Pylori ◽  
Triple Regimen ◽  
Meta Analyses ◽  
Cure Rates

H. pylori infection is the main cause of gastritis, gastroduodenal ulcer disease, and gastric cancer. Fluoroquinolones such as levofloxacin, or more recently moxifloxacin or sitafloxacin, are efficacious alternatives to standard antibiotics for H. pylori eradication. The aim of the present review is to summarize the role of quinolone-based eradication therapies, mainly focusing on the optimization strategies aimed to increase their efficacy. Several meta-analyses have shown that, after failure of a first-line eradication treatment, a levofloxacin-containing rescue regimen is at least equally effective, and better tolerated, than the generally recommended bismuth quadruple regimen. Compliance with the levofloxacin regimens is excellent, and the safety profile is favourable. Higher cure rates have been reported with longer treatments (>10–14 days), and 500 mg levofloxacin daily is the recommended dose. Adding bismuth to the standard triple regimen (PPI-amoxicillin-levofloxacin) has been associated with encouraging results. Unfortunately, resistance to quinolones is easily acquired and is increasing in most countries, being associated with a decrease in the eradication rate of H. pylori. In summary, a quinolone (mainly levofloxacin)-containing regimen is an encouraging second-line (or even third-line) strategy, and a safe and simple alternative to bismuth quadruple therapy in patients whose previous H. pylori eradication therapy has failed.

scholarly journals Rescue Therapy with Furazolidone in Patients with at Least Five Eradication Treatment Failures and Multi-Resistant H. pylori infection

Antibiotics ◽  
2021 ◽  
Vol 10 (9) ◽  
pp. 1028
Author(s):  
Elena Resina ◽  
Javier P. Gisbert
Keyword(s):  
Adverse Effects ◽  
Rescue Therapy ◽  
Efficacy And Safety ◽  
Stool Antigen Test ◽  
Ulcer Disease ◽  
Intention To Treat ◽  
Rescue Treatment ◽  
Resistant Infection ◽  
Stool Antigen ◽  
H Pylori

Helicobacter pylori infection may persist after multiple eradication treatments. The aim of this study was to evaluate the efficacy and safety of a furazolidone-based rescue regimen in hyper-refractory patients. A unicentre, prospective study was designed. Patients in whom five or more treatments had consecutively failed were included. All patients had previously received bismuth and key antibiotics, such as amoxicillin, clarithromycin, metronidazole, levofloxacin, tetracycline, and rifabutin, and had positive H. pylori culture, demonstrating resistance to clarithromycin, metronidazole, and levofloxacin. A quadruple regimen with furazolidone (200 mg), amoxicillin (1 g), bismuth (240 mg), and esomeprazole (40 mg) was prescribed twice a day for 14 days. Eradication was confirmed by the stool antigen test. Compliance was determined through questioning, and adverse effects using a questionnaire. Eight patients (mean age 56 years, 63% men, 38% peptic ulcer disease, 12% gastric cancer precursor lesions, and 50% functional dyspepsia) were included. Per-protocol and intention-to-treat eradication rates were 63%. Compliance was 100%. Adverse effects were reported in two (25%) patients, and all were mild. Even after five or more previous H. pylori eradication failures, and a multi-resistant infection, rescue treatment with furazolidone may be effective in approximately two-thirds of the cases, constituting a valid strategy after multiple previous eradication failures with key antibiotics such as clarithromycin, metronidazole, tetracycline, levofloxacin, and rifabutin.

scholarly journals Efficacy of and Resistance to Rifaximin-based Quadruple Therapy in Helicobacter pylori Eradication

2020 ◽  
Vol 20 (3) ◽  
pp. 218-224
Author(s):  
Hyun Soo Kim ◽  
Hyuk Yoon ◽  
Dong Woo Shin ◽  
Dong Jun Oh ◽  
Mingu Kwon ◽  
...  
Keyword(s):  
Helicobacter Pylori ◽  
Rescue Therapy ◽  
Treatment Options ◽  
Treatment Protocol ◽  
Resistance Rate ◽  
Quadruple Therapy ◽  
Minimal Inhibitory Concentrations ◽  
Intention To Treat ◽  
H Pylori ◽  
Triple Regimen

Background/Aims: The treatment options for Helicobacter pylori (<i>H. pylori</i>) infection are in a state of flux: traditional triple therapies have started to fail, and new treatments are unable to achieve optimal eradication rates. Rifaximin and rifabutin are new antibiotics. The aim of this study was to evaluate the efficacy and safety of adding rifaximin to the standard triple regimen and of a rifabutin-based triple regimen as a rescue therapy for <i>H. pylori</i> eradication.Materials and Methods: We enrolled 27 <i>H. pylori</i>-positive patients who were treated with a proton pump inhibitor, amoxicillin, clarithromycin, and rifaximin for 14 days. <i>H. pylori</i> eradication was assessed by a <sup>13</sup>C-urea breath test performed 4 weeks after therapy completion. The efficacy of the therapy was based on intention-to-treat (ITT) and per-protocol (PP) analysis. We also investigated the resistance rate, compliance, and side effects associated with rifaximin therapy. Minimal inhibitory concentrations and resistance to rifabutin were evaluated using the agar dilution method.Results: Of the 27 patients, 22 completed the treatment protocol with 100% compliance; five patients withdrew. The ITT and PP eradication rates for the rifaximin-containing quadruple therapy were 70.4% (19/27) and 86.3% (19/22), respectively. Adverse events were observed in five of 22 patients (22.7%). The resistance rates to rifaximin and rifabutin were 66.7% (2/3) and 0% (0/3), respectively.Conclusions: The findings of this study show the limitations of rifaximin-based quadruple therapy and suggest the benefits of a rifabutin-based rescue regimen in South Korea.

scholarly journals European Registry on Helicobacter pylori Management: single-capsule bismuth quadruple therapy is effective in real-world clinical practice

2020 ◽  
pp. 205064062097261
Author(s):  
Olga P Nyssen ◽  
Angeles Perez-Aisa ◽  
Manuel Castro-Fernandez ◽  
Rinaldo Pellicano ◽  
Jose M. Huguet ◽  
...  
Keyword(s):  
Helicobacter Pylori ◽  
Clinical Practice ◽  
Proton Pump Inhibitor ◽  
Proton Pump ◽  
Real World ◽  
Case Report Form ◽  
First Line ◽  
Quadruple Therapy ◽  
Intention To Treat ◽  
H Pylori

Background There has been resurgence in the use of bismuth quadruple therapy (proton pump inhibitor, bismuth, tetracycline and metronidazole) for treating Helicobacter pylori infection thanks to a three-in-one single-capsule formulation. Objective To evaluate the effectiveness and safety of the single-capsule bismuth quadruple therapy. Methods Data were collected in a multicentre, prospective registry of the clinical practice of gastroenterologists on the management of H. pylori infection, where patients were registered at the Asociación Española de Gastroenterología REDCap database on an electronic case report form until January 2020. Effectiveness by modified intention-to-treat and per-protocol as well as multivariable analysis were performed. Independent factors evaluated were: age, gender, indication, compliance, proton pump inhibitor dose and treatment line. Results Finally, 2100 patients were prescribed single-capsule bismuth quadruple therapy following the technical sheet (i.e. three capsules every 6 hours for 10 days). The majority of these patients were naive (64%), with an average age of 50 years, 64% women and 16% with peptic ulcer. An overall modified intention-to-treat effectiveness of 92% was achieved. Eradication was over 90% in first-line treatment (95% modified intention-to-treat, n = 1166), and this was maintained as a rescue therapy, both in second (89% modified intention-to-treat, n = 375) and subsequent lines of therapy (third to sixth line: 92% modified intention-to-treat, n = 236). Compliance was the factor most closely associated with treatment effectiveness. Adverse events were generally mild to moderate, and 3% of patients reported a severe adverse event, leading to discontinuation of treatment in 1.7% of cases. Conclusions Single-capsule bismuth quadruple therapy achieved H. pylori eradication in approximately 90% of patients in real-world clinical practice, both as a first-line and rescue treatment, with good compliance and a favourable safety profile.

scholarly journals Is It Time for Quadruple Therapy to be First Line?

2003 ◽  
Vol 17 (suppl b) ◽  
pp. 33B-35B ◽  
Author(s):  
Loren Laine
Keyword(s):  
Triple Therapy ◽  
Randomized Trials ◽  
Eradication Rate ◽  
First Line ◽  
Quadruple Therapy ◽  
First Line Therapy ◽  
Clarithromycin Resistance ◽  
Line Therapy ◽  
Metronidazole Resistance ◽  
H Pylori

The most commonly used regimen forHelicobacter pyloritherapy at present is twice-daily proton pump inhibitor (PPI)-based triple therapy. Bismuth-based therapy is the next most common treatment used by gastroenterologists. When a PPI is combined with bismuth-based triple therapy (quadruple therapy), eradication rates are increased as compared with the triple therapy alone. Three separate randomized trials from three continents that compare quadruple therapy and PPIbased triple therapy revealed remarkably similar results. Eradication rates with PPI-based triple therapy and quadruple therapy were not significantly different. The eradication rates with quadruple therapy were 3% to 6% higher than PPI triple therapy, indicating that quadruple therapy should be no less effective than PPI triple therapy. Furthermore, these two therapies had similar rates of compliance and adverse events.The major potential benefit of the quadruple therapy relates to antibiotic resistance. In patients with clarithromycin resistance, PPIbased triple therapy, but not quadruple therapy, had a significantly lower eradication rate. However, due to its ability to largely overcome metronidazole resistance, quadruple therapy had little if any decrement in eradication rates compared with PPI triple therapy in patients with metronidazole-resistantH pylori. Therefore, quadruple therapy can be considered a first line therapy forH pylori.

scholarly journals Thin layer immunoassay; an economical approach to diagnose Helicobacter pylori Infection in gastroduodenal ulcer disease patients of Pakistan; a comparative analysis

2020 ◽  
Author(s):  
Faisal Aziz ◽  
Yasmeen Taj ◽  
Shahana Urooj Kazmi
Keyword(s):  
Helicobacter Pylori ◽  
Thin Layer ◽  
Low Cost ◽  
Gastroduodenal Ulcer ◽  
Blood Samples ◽  
Ulcer Disease ◽  
Water Condensation ◽  
Condensation Pattern ◽  
Polystyrene Plate ◽  
H Pylori

AbstractHelicobacter pylori is a causative agent of gastritis, gastroduodenal ulcers and gastric adenocarcinoma. Gastric patient’s serums were screened for H. pylori infection by thin layer immunoassay. A polystyrene plate coated with H. pylori sonicate whole cell antigen (10 μg/ml). Two fold-diluted patient’s serum was allowed to react at 37 °C, incubated at 60 °C for 1 min over water bath and recorded water condensation pattern for H. pylori antibody. Gastric patient’s blood samples (62% male and 6% female) were tested positive for H. pylori, while agewise 15–25 years males (36%) and 65–75 years females (50%) showed highest number of H. pylori infection. Thin layer immunoassay showed sensitivity (72–67%), specificity (100%), accuracy (94–69%) and κ value (0.493–0.357) in comparison with wELISA, sELISA and kELISA. We conclude thin layer immunoassay was reliable, low cost, quick, simple and clinically useful method for H. pylori diagnosis in patients of Pakistan.

Third-Line Rescue Therapy with Bismuth-Containing Quadruple Regimen After Failure of Two Treatments (with Clarithromycin and Levofloxacin) for H. pylori Infection

2013 ◽  
Vol 59 (2) ◽  
pp. 383-389 ◽  
Author(s):  
J. P. Gisbert ◽  
◽  
A. Perez-Aisa ◽  
L. Rodrigo ◽  
J. Molina-Infante ◽  
...  
Keyword(s):  
Rescue Therapy ◽  
Third Line ◽  
H Pylori

scholarly journals Molecular typing ofHelicobacter pyloriisolates from asymptomatic, ulcer and gastritis patients by urease gene polymorphism

1994 ◽  
Vol 112 (1) ◽  
pp. 151-160 ◽  
Author(s):  
M. Desai ◽  
D. Linton ◽  
R. J. Owen ◽  
J. Stanley
Keyword(s):  
Molecular Typing ◽  
The Other ◽  
Disease Symptoms ◽  
Restriction Fragments ◽  
Ulcer Disease ◽  
Urease Gene ◽  
Gastroduodenal Disease ◽  
H Pylori ◽  
Asymptomatic Individuals ◽  
Almost All

SummaryThe gastric-adapted bacteriumHelicobacter pyloriplays an important role in gastritis and ulcer disease, but no phenotypic typing scheme presently exists for this organism. With a view to the development of genotypic typing, we have compared isolates ofH. pylorifrom gastritis or ulcer patients with those from subjects exhibiting no disease. Variation was analysed at the urease genes,ureA andureCD, by employing PCR-generated probes in genomic Southern blot hybridizations. WhilstureA restriction fragments provided a fourfold subgrouping of strains,ureCD fragments were considerably more discriminatory. Twenty-four combinedureACD profiles were generated withHindIII, subdividing the 64 strains into 11 types and 13 single profiles. The most prevalent profile (UI) was found in 33% of strains, almost all from gastritis or ulcer patients. On the other hand strains isolated from asymptomatic individuals had the most diverseureACD profiles. A key finding from this set of isolates was that strains ofH. pyloriassociated with general gastroduodenal disease were genetically more homogeneous than strains carried by people without disease symptoms.

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