scholarly journals High Dose Ilaprazole/Amoxicillin as First-Line Regimen forHelicobacter pyloriInfection in Korea

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
WonGun Kwack ◽  
YunJeong Lim ◽  
ChiYeon Lim ◽  
David Y. Graham
Keyword(s):  
Side Effects ◽  
Dual Therapy ◽  
High Dose ◽  
Cure Rate ◽  
First Line ◽  
Intention To Treat ◽  
First Line Therapy ◽  
Standard Triple Therapy ◽  
Treatment Naïve ◽  
H Pylori

Objective. The eradication rate ofHelicobacter pylori(H. pylori) following standard triple therapy has declined over the past few decades. This study has determined whether high dose dual therapy (PPI and amoxicillin) is adequate for eradicatingH. pyloriin Korea.Methods. This was an open-labeled study ofH. pyloriinfected treatment-naive patients. Subjects received dual therapy for 14 days: ilaprazole 40 mg tablets given twice a day and amoxicillin 750 mg tablets given 4 times a day. At the end of the therapy, the subjects visited the clinic to confirm compliance and monitor for any side effects. Subjects visited again after 4–6 weeks to confirmH. pyloristatus through a urea breath test.Results.The cure rate ofH. pyloriwas 79.3% (23 of 29) (95% confidence interval: 61.6–90.2) in the intention-to-treat analysis and 82.1% (23 of 28) in the per-protocol analysis. Compliance rates were high (96.6%) and side effects were minimal and tolerable.Conclusion.A high dose of ilaprazole + amoxicillin was ineffective as the first-line therapy for eradicatingH. pyloriin Korea. Future studies should focus on intragastric pH measurements and assess amoxicillin resistance.

scholarly journals European Registry on Helicobacter pylori Management: Effectiveness of First and Second-Line Treatment in Spain

Antibiotics ◽  
2020 ◽  
Vol 10 (1) ◽  
pp. 13
Author(s):  
María Caldas ◽  
Ángeles Pérez-Aisa ◽  
Manuel Castro-Fernández ◽  
Luis Bujanda ◽  
Alfredo Lucendo ◽  
...  
Keyword(s):  
Helicobacter Pylori ◽  
Second Line ◽  
Cure Rate ◽  
Management Effectiveness ◽  
First Line ◽  
Intention To Treat ◽  
First Line Therapy ◽  
Line Therapy ◽  
H Pylori ◽  
European Registry

The management of Helicobacter pylori infection has to rely on previous local effectiveness due to the geographical variability of antibiotic resistance. The aim of this study was to evaluate the effectiveness of first and second-line H. pylori treatment in Spain, where the empirical prescription is recommended. A multicentre prospective non-interventional registry of the clinical practice of European gastroenterologists concerning H. pylori infection (Hp-EuReg) was developed, including patients from 2013 until June 2019. Effectiveness was evaluated descriptively and through a multivariate analysis concerning age, gender, presence of ulcer, proton-pump inhibitor (PPI) dose, therapy duration and compliance. Overall, 53 Spanish hospitals were included, and 10,267 patients received a first-line therapy. The best results were obtained with the 10-day bismuth single-capsule therapy (95% cure rate by intention-to-treat) and with both the 14-day bismuth-clarithromycin quadruple (PPI-bismuth-clarithromycin-amoxicillin, 91%) and the 14-day non-bismuth quadruple concomitant (PPI-clarithromycin-amoxicillin-metronidazole, 92%) therapies. Second-line therapies were prescribed to 2448 patients, with most-effective therapies being the triple quinolone (PPI-amoxicillin-levofloxacin/moxifloxacin) and the bismuth-levofloxacin quadruple schemes (PPI-bismuth-levofloxacin-amoxicillin) prescribed for 14 days (92%, 89% and 90% effectiveness, respectively), and the bismuth single-capsule (10 days, 88.5%). Compliance, longer duration and higher acid inhibition were associated with higher effectiveness. “Optimized” H. pylori therapies achieve over 90% success in Spain.

scholarly journals High-Dose Dual Therapy versus Triple Therapy for Treatment of H. Pylori Infection: A Parallel Randomized Study

2020 ◽  
Vol 11 (SPL4) ◽  
pp. 2158-2164
Author(s):  
Aya Ahmed ◽  
Gehan F Balata ◽  
Hany M Elsadek ◽  
Mohamed Nour EL-Din ◽  
Ahmed Amin
Keyword(s):  
Side Effects ◽  
Triple Therapy ◽  
Patient Adherence ◽  
Randomized Study ◽  
Dual Therapy ◽  
High Dose ◽  
University Hospitals ◽  
First Line ◽  
Stool Antigen Test ◽  
H Pylori

The prevalence of antibiotic resistance has considerably increased and as a result, the elimination pace of Helicobacter pylori (H.pylori) infection have decreased significantly to an unacceptable level. High dose dual therapy (HDDT) has been suggested as an alternative to standard triple therapy (TT) for the first-line treatment of H. pylori infection. The aim of the present work was to compare the effectiveness and tolerability of HDDT with standard TT, for treatment of H. pylori infection. This randomized parallel interventional study was carried out on 130 treatment naïve H. pylori infected patients, selected from outpatient clinic of Hepatology and Gastroenterology department of Zagazig University Hospitals, in the duration between November 2017 and December 2018. All patients were H. pylori positive as was evidenced by stool antigen test. Patients were divided into two groups; group A (n=65) received a 14-day HDDT (esomeprazole 40 mg twice daily and amoxicillin 1 g three times daily) whereas group B (n=65) received a 14-day TT (esomeprazole 20 mg, amoxicillin 1 g and clarithromycin 500 mg, each administered twice daily). Eradication rates, side effects and drug compliance were compared among both groups. The eradication rate between the two regimens was not significantly different. The eradication rates were 80% for TT and 72.3% for HDDT (P= 0.3). No significant differences were observed between both groups regarding the side effects or patient adherence. HDDT is as effective and safe as TT as empiric first-line therapy for H pylori infection.

scholarly journals A 14-Day Course of Triple Therapy is Superior to a 10-Day Course for the Eradication ofHelicobacter pylori: A Canadian Study Conducted in a ‘Real World’ Setting

2015 ◽  
Vol 29 (8) ◽  
pp. e7-e10 ◽  
Author(s):  
Yen-I Chen ◽  
Carlo A Fallone
Keyword(s):  
Triple Therapy ◽  
Eradication Rate ◽  
Day Treatment ◽  
Office Visit ◽  
First Line ◽  
Intention To Treat ◽  
Treatment Naïve ◽  
Gastric Biopsies ◽  
H Pylori ◽  
Treat Analysis

BACKGROUND: SuccessfulHelicobacter pylorieradication with the traditional seven-day course of proton pump inhibitor (PPI) triple therapy is declining. Prolonging therapy to either 10 or 14 days is associated with better eradications rates.OBJECTIVE: To compare the effectiveness of 14-day course of triple therapy versus a 10-day course in the treatment ofH pyloriin Canada.METHODS: Consecutive treatment-naive patients with clinical indications forH pylorieradication underwent either a 10-day course or a 14-day course of traditional PPI triple therapy depending on the date of the office visit (an odd date received the 10-day course, whereas an even date received the 14-day treatment).H pylorieradication was ascertained via urea breath test or gastric biopsies performed ≥4 weeks after completion of therapy. Analyses were by both intention to treat and per-protocol.RESULTS: A total of 83 patients were included in the study (31 in the 10-day group and 52 in the 14-day group). In the intention-to-treat analysis, eradication rates were 82.7% (95% CI 70% to 92%) versus 45.2% (95% CI 27% to 64%), favouring the 14-day treatment (P<0.001). Similarly, in the per-protocol analysis, eradication rates were 91.5% (95% CI 80% to 98%) versus 63.6% (95% CI 41% to 83%), favouring the 14-day arm (P=0.01). Adverse events and compliance were not significantly different between the two groups.CONCLUSION: A 14-day course of standard PPI triple therapy was superior to a shorter-duration therapy and should be included as a first-line regimen forH pylorieradication in Canada. The 10-day course of treatment did not achieve an acceptable eradication rate and should no longer be used in this country.

scholarly journals Helicobacter pyloriInfection: Is Sequential Therapy Superior to Standard Triple Therapy? A Single-Centre Italian Study in Treatment-Naive and Non-Treatment-Naive Patients

2011 ◽  
Vol 25 (6) ◽  
pp. 315-318 ◽  
Author(s):  
R Urgesi ◽  
G Pelecca ◽  
R Cianci ◽  
A Masini ◽  
C Zampaletta ◽  
...  
Keyword(s):  
Triple Therapy ◽  
Breath Test ◽  
Sequential Therapy ◽  
Urea Breath Test ◽  
First Line ◽  
Randomized Controlled ◽  
Standard Triple Therapy ◽  
End Of Treatment ◽  
Treatment Naïve ◽  
H Pylori

BACKGROUND: Clarithromycin resistance has decreased the eradication rates ofHelicobacter pylori.AIMS: To determine whether a 10-day course of sequential therapy (ST) is more effective at eradicatingH pyloriinfection than triple therapy (TT) in the first or second line, and to assess side effects and compliance with therapy.METHODS: One hundred sixty treatment-naive and 40 non-treatment-naive patients who were positive forH pyloriinfection by13C-urea breath test or endoscopy were enrolled. Eighty of 160 patients underwent TT, while 80 of 160 underwent ST with omeprazole (20 mg) plus amoxicillin (1 g) twice/day for five days, followed by omeprazole (20 mg) with tinidazole (500 mg) twice/day and clarithromycin (500 mg) twice/day for five consecutive days.H pylorieradication was evaluated by13C-urea breath test no sooner than four weeks after the end of treatment.RESULTS: Eradication was achieved in 59 of 80 treatment-naive patients treated with TT (74%), in 74 of 80 patients treated with ST (93%), and in 38 of 40 non-treatment-naive patients (95%). Eradication rates in treatment-naive patients with ST were statistically significantly higher than TT (92.5% versus 73.7%; P=0.0015; OR 4.39 [95% CI 1.66 to 11.58]). Mild adverse effects were reported for both regimens.CONCLUSIONS: ST appears to be a well-tolerated, promising therapy; however, randomized controlled trials with larger and more diverse sample populations are needed before it can be recommended as a first-line treatment.

scholarly journals Best Helicobacter pylori Eradication Strategy in the Era of Antibiotic Resistance

Antibiotics ◽  
2020 ◽  
Vol 9 (8) ◽  
pp. 436 ◽  
Author(s):  
Su Young Kim ◽  
Jun-Won Chung
Keyword(s):  
Helicobacter Pylori ◽  
Antibiotic Resistance ◽  
Resistance Rate ◽  
First Line ◽  
Helicobacter Pylori Eradication ◽  
First Line Therapy ◽  
Standard Triple Therapy ◽  
Eradication Strategy ◽  
Helicobacter Pylori Treatment ◽  
H Pylori

Antibiotic resistance is the major reason for Helicobacter pylori treatment failure, and the increasing frequency of antibiotic resistance is a challenge for clinicians. Resistance to clarithromycin and metronidazole is a particular problem. The standard triple therapy (proton pump inhibitor, amoxicillin, and clarithromycin) is no longer appropriate as the first-line treatment in most areas. Recent guidelines for the treatment of H. pylori infection recommend a quadruple regimen (bismuth or non-bismuth) as the first-line therapy. This treatment strategy is effective for areas with high resistance to clarithromycin or metronidazole, but the resistance rate inevitably increases as a result of prolonged therapy with multiple antibiotics. Novel potassium-competitive acid blocker-based therapy may be effective, but the data are limited. Tailored therapy based on antimicrobial susceptibility test results is ideal. This review discussed the current important regimens for H. pylori treatment and the optimum H. pylori eradication strategy.

scholarly journals A Randomized Controlled Trial Comparing Sequential with Triple Therapy forHelicobacter pyloriin an Aboriginal Community in the Canadian North

2013 ◽  
Vol 27 (12) ◽  
pp. 701-706 ◽  
Author(s):  
Amy L Morse ◽  
Karen J Goodman ◽  
Rachel Munday ◽  
Hsiu-Ju Chang ◽  
John Morse ◽  
...  
Keyword(s):  
Triple Therapy ◽  
Treatment Effectiveness ◽  
Controlled Trial ◽  
Alternative Therapy ◽  
Sequential Therapy ◽  
Aboriginal Community ◽  
Intention To Treat ◽  
Standard Triple Therapy ◽  
Treatment Naïve ◽  
H Pylori

BACKGROUND:Helicobacter pyloriinfection occurs more frequently in Arctic Aboriginal settings than elsewhere in North America and Europe. Research aimed at reducing health risks fromH pyloriinfection has been conducted in the Aboriginal community of Aklavik, Northwest Territories.OBJECTIVE: To compare the effectiveness of the Canadian standard therapy with an alternative therapy for eliminatingH pyloriinfection in Aklavik.METHODS: Treatment-naiveH pylori-positive individuals were randomly assigned to a 10-day regimen (oral twice-daily doses) with rabeprazole (20 mg): standard triple therapy (proton pump inhibitor, added clarithromycin [500 mg] and amoxicillin [1 g] [PPI-CA]); sequential therapy (ST) added amoxicillin (1 g) on days 1 to 5, and metronidazole (500 mg) and clarithromycin (500 mg) on days 6 to 10. Participants with clarithromycin-resistantH pyloriwere randomly assigned to ST or quadruple therapy. Treatment effectiveness was estimated as per cent (95% CI) with a negative urea breath test at least 10 weeks after treatment.RESULTS: Of 104 (53 PPI-CA, 51 ST) randomized participants, 89 (49 PPI-CA, 40 ST) had post-treatment results. Per-protocol treatment effectiveness was 59% (95% CI 45% to 73%) for PPI-CA and 73% (95% CI 58% to 87%) for ST. Based on intention to treat, effectiveness was 55% (95% CI 41% to 69%) for PPI-CA and 57% (95% CI 43% to 71%) for ST. Of 77 participants (43 PPI-CA, 34 ST) with 100% adherence, effectiveness was 63% (95% CI 43% to 82%) for PPI-CA and 81% (95% CI 63% to 99%) for ST.CONCLUSIONS: While additional evidence is needed to confirm that ST is more effective for Arctic Aboriginal communities than the Canadian standardH pyloritreatment, these results show standard PPI-CA treatment to be inadequate for communities such as Aklavik.

scholarly journals Two-week Triple Therapy with either Standard or High-dose Esomeprazole for First-line H. pylori Eradication

2016 ◽  
Vol 25 (2) ◽  
pp. 147-150 ◽  
Author(s):  
Vincenzo De Francesco ◽  
Lorenzo Ridola ◽  
Cesare Hassan ◽  
Annamaria Bellesia ◽  
Domenico Alvaro ◽  
...  
Keyword(s):  
Triple Therapy ◽  
Proton Pump ◽  
High Dose ◽  
Double Dose ◽  
First Line ◽  
Therapy Regimen ◽  
Dose Therapy ◽  
Intention To Treat ◽  
Significant Difference ◽  
H Pylori

Background & Aims: The updated Italian guidelines advise a standard 14-day triple therapy for first-line H. pylori eradication. This prospective study evaluated the cure rate following a 14-day triple therapy with either a standard or double-dose proton pump inhibitor (PPI). Methods. A total of 145 consecutive patients with H. pylori infection were randomized to receive a 14-day, first-line triple therapy with clarithromycin 500 mg, amoxicillin 1 g and esomeprazole at either 20 mg (standard therapy) or 40 mg (double-dose therapy), each given twice daily. Results. At intention-to-treat analysis, H. pylori infection was cured in 73.9% (95% CI: 63.9−84) and 81.9% (95% CI: 73−90.8) following standard and double-dose therapy, respectively, and in 78.2% (95% CI: 68.5−87.9) and 85.5% (95% CI: 77.2−93.8) at per-protocol analysis. No statistically significant difference occurred. Overall, 16.4% and 19.4% patients in the standard and double-dose therapy regimen complained of side effects. Conclusion. The success rate of both standard and double-dose 14-day triple therapies for first-line H. pylori treatment was unsatisfactory. A prolonged 14-day levofloxacin-based triple therapy for second-line H. pylori eradication seems to be promising. Abbrevations: ITT: Intention To Treat; NUD: non ulcer dyspepsia; PP: PerAdd Contributor Protocol; PPI: proton pump inhibitors; PUD: peptic ulcer disease; UBT: urea breath test.

EFFICACY OF 10 - DAY LEVOFLOXACIN CONTAINING SEQUENTIAL THERAPY IN PATIENTS WITH HELICOBACTER PYLORI–ASSOCIATED CHRONIC GASTRITIS

2017 ◽  
pp. 14-21
Author(s):  
Phan Hong Ngoc Nguyen ◽  
Van Huy Tran
Keyword(s):  
Side Effects ◽  
Clinical Symptoms ◽  
Sequential Therapy ◽  
First Line ◽  
Intention To Treat ◽  
Clarithromycin Resistance ◽  
Central Vietnam ◽  
Urease Test ◽  
High Prevalence ◽  
H Pylori

Background: The increasing of antibiotic resistance in H. pylori has become a main cause for treatment failure. A 10-day levofloxacin containing sequential therapy is efficient and safe in eradication H. pylori infection in an area with high prevalence of clarithromycin resistance. Aims: To evaluate the efficacy of 10day levofloxacin containing sequential therapy as first-line treatment for H. pylori eradication, side effects, symptoms and endoscopic responses and improvement of histological features in Centre Vietnam. Patients and methods: 120 Naïve H. pylori positive patients were received levofloxacin containing sequential therapy (rabeprazole 20mg twice daily, amoxicillin 1g twice daily for 5 days followed by rabeprazole 20mg, levofloxacin 500mg, and tinidazole 500mg, twice daily for 5 more days). These patients tested positive for H. pylori by urease test and gastric mucosal biopsy presented mononuclear cell infiltrating in lamina propria. Results: Intention to treat (ITT) eradication rates of RA-RLT was 73.5%. Per protocol (PP) eradication rates were 81.5%. Overall, 33.7% experienced mild to moderate adverse events. No patient stopped the treatment because of side effects. 6 months after H. pylori eradication clinical symptoms and only edema undergoing endoscopy significantly improved. Grade of activity inflammation and stage of gastritis significantly decreased at 6 months. Intestinal metaplasia and dysplasia did not change significantly at 6 months. Conclusion: 10day levofloxacin containing sequential therapy may be considered as one of the first choices in H. pylori eradication in Central Vietnam. H. pylori eradication may improve clinical symptoms, inflammative activity and stage of gastritis in histology. Key words: H. pylori, gastritis, levofloxacin

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