scholarly journals Empirical or susceptibility-guided treatment for Helicobacter pylori infection? A comprehensive review

2020 ◽  
Vol 13 ◽  
pp. 175628482096873
Author(s):  
Javier P. Gisbert
Keyword(s):  
Helicobacter Pylori ◽  
Clinical Practice ◽  
Helicobacter Pylori Infection ◽  
Alternative Methods ◽  
First Line ◽  
Time Saving ◽  
Line Therapy ◽  
H Pylori ◽  
Guided Therapy

Although susceptibility-guided therapy is frequently recommended for Helicobacter pylori infection, the evidence available to date supporting this strategy is limited. The aim of the present article is to review the advantages and limitations of the susceptibility-guided and the empirical strategies to treat this infection. We performed a bibliographic search to identify studies investigating H. pylori susceptibility-guided therapy. Culture is not the only way to assess antibiotic resistance, as different polymerase chain reaction-based approaches have been developed as alternative methods. For detecting H. pylori antimicrobial resistance, a molecular approach based on a stool sample might enable more convenient, time-saving methods. Unfortunately, the antimicrobial susceptibility cannot be obtained in all cases. Furthermore, antibiotic susceptibility testing in clinical practice yields useful information only for a few antibiotics: clarithromycin, metronidazole, and quinolones. In addition, susceptibility towards clarithromycin and metronidazole in vitro does not necessarily lead to eradication in vivo. In the case of H. pylori therapy failure, we should not re-administer any of the antibiotics against which H. pylori has probably become resistant. Our updated meta-analysis showed that susceptibility-guided treatment is not better than empirical treatment of H. pylori infection in first-line therapy if the most updated quadruple regimens are empirically prescribed, and similar efficacy results were also demonstrated with the two strategies for second-line therapy. Cumulative H. pylori eradication rate with several successive rescue therapies empirically prescribed reaches almost 100%. Finally, the studies that have evaluated the cost-effectiveness of the susceptibility-guided treatment have achieved contradictory results. In summary, we can conclude that the evidence is too limited to support the generalized use of susceptibility-guided therapy for H. pylori treatment in routine clinical practice, either as first-line or as rescue treatment. Nevertheless, it would be recommended that susceptibility tests are performed routinely, even before prescribing first-line treatment, in specialized centers with an interest in H. pylori management.

scholarly journals A High-Throughput Metabolic Microarray Assay Reveals Antibacterial Effects of Black and Red Raspberries and Blackberries against Helicobacter pylori Infection

Antibiotics ◽  
2021 ◽  
Vol 10 (7) ◽  
pp. 845
Author(s):  
Candace Goodman ◽  
Katrina N. Lyon ◽  
Aitana Scotto ◽  
Cyra Smith ◽  
Thomas A. Sebrell ◽  
...  
Keyword(s):  
Helicobacter Pylori ◽  
High Throughput ◽  
Antibacterial Properties ◽  
Treatment Strategies ◽  
Helicobacter Pylori Infection ◽  
Antibacterial Effects ◽  
Biolog System ◽  
Freeze Dried ◽  
H Pylori

Helicobacter pylori infection is commonly treated with a combination of antibiotics and proton pump inhibitors. However, since H. pylori is becoming increasingly resistant to standard antibiotic regimens, novel treatment strategies are needed. Previous studies have demonstrated that black and red berries may have antibacterial properties. Therefore, we analyzed the antibacterial effects of black and red raspberries and blackberries on H. pylori. Freeze-dried powders and organic extracts from black and red raspberries and blackberries were prepared, and high-performance liquid chromatography was used to measure the concentrations of anthocyanins, which are considered the major active ingredients. To monitor antibiotic effects of the berry preparations on H. pylori, a high-throughput metabolic growth assay based on the Biolog system was developed and validated with the antibiotic metronidazole. Biocompatibility was analyzed using human gastric organoids. All berry preparations tested had significant bactericidal effects in vitro, with MIC90 values ranging from 0.49 to 4.17%. Antimicrobial activity was higher for extracts than powders and appeared to be independent of the anthocyanin concentration. Importantly, human gastric epithelial cell viability was not negatively impacted by black raspberry extract applied at the concentration required for complete bacterial growth inhibition. Our data suggest that black and red raspberry and blackberry extracts may have potential applications in the treatment and prevention of H. pylori infection but differ widely in their MICs. Moreover, we demonstrate that the Biolog metabolic assay is suitable for high-throughput antimicrobial susceptibility screening of H. pylori.

scholarly journals Additive Effect of Pronase on the Eradication Rate of First-Line Therapy for Helicobacter pylori Infection

Gut and Liver ◽  
2015 ◽  
Vol 9 (3) ◽  
Author(s):  
Chang Seok Bang ◽  
Yeon Soo Kim ◽  
Sang Hyun Park ◽  
Jin Bong Kim ◽  
Gwang Ho Baik ◽  
...  
Keyword(s):  
Helicobacter Pylori ◽  
Eradication Rate ◽  
Helicobacter Pylori Infection ◽  
Additive Effect ◽  
First Line ◽  
First Line Therapy ◽  
Line Therapy

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.

Modified bismuth quadruple therapy with low‐dose metronidazole as first‐line therapy for Helicobacter pylori infection

Helicobacter ◽  
2020 ◽  
Author(s):  
Gyu Young Pih ◽  
Kee Don Choi ◽  
Eun Jeong Gong ◽  
Hee Kyong Na ◽  
Ji Yong Ahn ◽  
...  
Keyword(s):  
Helicobacter Pylori ◽  
Low Dose ◽  
Helicobacter Pylori Infection ◽  
First Line ◽  
Quadruple Therapy ◽  
First Line Therapy ◽  
Line Therapy

Quadruple concomitant non-bismuth therapy vs. classical triple therapy as first line therapy for Helicobacter pylori infection

2016 ◽  
Vol 147 (5) ◽  
pp. 199-201
Author(s):  
Ana Campillo ◽  
Miriam Ostiz ◽  
Edurne Amorena ◽  
Marcos Kutz ◽  
Matilde La Iglesia
Keyword(s):  
Helicobacter Pylori ◽  
Triple Therapy ◽  
Helicobacter Pylori Infection ◽  
First Line ◽  
First Line Therapy ◽  
Line Therapy

Levofloxacin-versus clarithromycin-based first line therapy for helicobacter pylori infection

2006 ◽  
Vol 38 ◽  
pp. S72
Author(s):  
A. Rispo ◽  
E. Di Girolamo ◽  
A. Cozzolino ◽  
L.M.A.T. Hamma ◽  
L. Pasquale
Keyword(s):  
Helicobacter Pylori ◽  
Helicobacter Pylori Infection ◽  
First Line ◽  
First Line Therapy ◽  
Line Therapy

scholarly journals Efficacy of two-week quadruple bismuth treatment versus levofloxacin concomitant Helicobacter Pylori infection regimen as empirical first-line therapy Syrian patients. A randomized controlled trial.

2020 ◽  
Author(s):  
Marouf Muhammad Alhalabi ◽  
Mohammed Waleed Alassi ◽  
Kamal Alaa Eddin ◽  
Khaled Cheha
Keyword(s):  
Randomized Controlled Trial ◽  
Helicobacter Pylori ◽  
Controlled Trial ◽  
Helicobacter Pylori Infection ◽  
First Line ◽  
Open Label ◽  
Randomized Controlled ◽  
First Line Therapy ◽  
Line Therapy

Abstract Introduction: Antibiotic-resistant reduces the efficacy of conventional triple therapy for Helicobacter Pylori infections worldwide, lead to varying treatment protocols according to locations.Aim: Primary outcome was eradication rates of bismuth quadruple (BQ) and levofloxacin concomitant (LC) as empirical first-line treatment by intention to treat (ITT) in a referral hospital in Syria.Design: an open‑label parallel blind randomized controlled trial.Materials and Methods: We randomly assigned seventy-eight naïve who tested positive for Helicobacter Pylori gastric infection, with a 1:1 ratio to receive either BQ (bismuth subsalicylate 524 mg four times daily, doxycycline 100 mg, tinidazole 500 mg, and esomeprazole 20 mg, each twice daily for two weeks), or LC (levofloxacin 500 mg daily, tinidazole 500 mg, amoxicillin 1000 mg, and esomeprazole 20 mg each twice daily for two weeks). We confirmed Helicobacter Pylori eradication by stool antigen test by eight weeks.Results: Thirty-nine patients were allocated in each group. In the BQ group, thirty-eight patients completed the follow-up, thirty patients were cured. While in the LC group, thirty-nine completed the follow-up, thirty-two patients were cured. The ITT eradication rates of the BQ and LC groups were 76.92%, and 82.05%, respectively. Odds ratio with 95% confidence interval according to ITT was 1.371 [0.454-4.146]. We didn’t report serious adverse effects.Conclusions:Both therapy regimens had acceptable rates of eradication. we suggest using both regimens as empirical first-line therapy in the treatment of Helicobacter Pylori infection in the Syrian population.Clinicaltrial.gov, NCT04348786

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