scholarly journals Rescue therapy with rifabutin regimen for refractory Helicobacter pylori infection with dual drug-resistant strain

2020 ◽  
Author(s):  
Chia-Jung Kuo ◽  
Cheng-Yu Lin ◽  
Puo-Hsien Le ◽  
Pi-Yueh Chang ◽  
Chih-Ho Lai ◽  
...  
Keyword(s):  
Helicobacter Pylori ◽  
Triple Therapy ◽  
Eradication Rate ◽  
Rescue Therapy ◽  
Univariate Analysis ◽  
Drug Resistant ◽  
Resistant Strains ◽  
H Pylori ◽  
Drug Resistant Strains ◽  
Dual Drug

Abstract Background: There is no current standard rescue treatment for dual drug-resistant strains of Helicobacter pylori. This aim of this study was to investigate the efficacy of rifabutin-based triple therapy for patients infected with dual drug-resistant strains to clarithromycin and levofloxacin.Methods: After two or three H. pylori treatment failures, patients underwent upper endoscopy with tissue biopsies. Phenotypic and genotypic resistance was determined using agar dilution test and polymerase chain reaction with direct sequencing, respectively. Patients infected with dual drug-resistant (clarithromycin and levofloxacin) strains and received rifabutin based triple therapy (rifabutin 150 mg bid, amoxicillin 1 g bid and esomeprazole 40 mg bid for 10 days) were enrolled. Eradication status was determined by 13C-urea breath test four weeks after treatment completion. Results: A total of 39 patients infected with dual drug-resistant strains were enrolled in this study, with a mean age of 55.9 years. The eradication rate was 79.5% (31/39). Adverse event was reported in 23.1% (9/39) of patients but mild and tolerable. In univariate analysis, no factor was identified as an independent predictor of eradication failure. Conclusions: Our current study demonstrated that rifabutin-based triple therapy was well tolerated and yielded an acceptable eradication rate for patients infected with dual drug-resistant strains of H. pylori.

scholarly journals Helicobacter pylori Accumulates Photoactive Porphyrins and Is Killed by Visible Light

2005 ◽  
Vol 49 (7) ◽  
pp. 2822-2827 ◽  
Author(s):  
Michael R. Hamblin ◽  
Jennifer Viveiros ◽  
Changming Yang ◽  
Atosa Ahmadi ◽  
Robert A. Ganz ◽  
...  
Keyword(s):  
Helicobacter Pylori ◽  
Visible Light ◽  
Propionibacterium Acnes ◽  
Protoporphyrin Ix ◽  
Human Stomach ◽  
Drug Resistant ◽  
Violet Light ◽  
Resistant Strains ◽  
H Pylori ◽  
Drug Resistant Strains

ABSTRACT Helicobacter pylori colonizes the mucus layer of the human stomach and duodenum, causes chronic gastritis, gastric ulcer, and is a risk factor for gastric adenocarcinoma. There is a 20% failure rate in antibiotic therapy, which is increasingly due to antibiotic resistance and necessitates the search for alternative antimicrobial methods. We have discovered that H. pylori when cultured in liquid medium, accumulates significant quantities of coproporphyrin and protoporphyrin IX, both in the cells and secreted into the medium. These photoactive porphyrins lead to cell death (up to 5 logs) by photodynamic action upon illumination with low doses of visible light, with blue/violet light being most efficient. The degree of killing increases with the age of the culture and is greater than that found with Propionibacterium acnes (another bacterium known to be photosensitive due to porphyrin accumulation). Both virulent and drug-resistant strains are killed. The data suggest that phototherapy might be used to treat H. pylori infection in the human stomach.

scholarly journals Vonoprazan-Based Third-Line Therapy Has a Higher Eradication Rate against Sitafloxacin-Resistant Helicobacter pylori

Cancers ◽  
2019 ◽  
Vol 11 (1) ◽  
pp. 116 ◽  
Author(s):  
Yoshimasa Saito ◽  
Kaho Konno ◽  
Moeka Sato ◽  
Masaru Nakano ◽  
Yukako Kato ◽  
...  
Keyword(s):  
Helicobacter Pylori ◽  
Success Rate ◽  
Triple Therapy ◽  
Eradication Rate ◽  
Eradication Therapy ◽  
Drug Resistant ◽  
Success Rates ◽  
Line Therapy ◽  
Third Line ◽  
H Pylori

Eradication of Helicobacter pylori (H. pylori) is an effective strategy for preventing various gastrointestinal diseases such as gastric cancer and mucosa-associated lymphoid tissue (MALT) lymphoma. However, the eradication success rate is decreasing because of a recent increase in drug-resistant strains of H. pylori. Here, we evaluated the success rate of eradication therapy with vonoprazan (VPZ), a new potassium-competitive acid blocker, against drug-resistant H. pylori. In total, 793 patients who received H. pylori eradication therapy were investigated retrospectively. All underwent esomeprazole (EPZ)-based triple therapy (n = 386) or VPZ-based triple therapy (n = 407) for first-, second- and third-line H. pylori eradication for 7 days. The overall success rates of first- and third-line H. pylori eradication were significantly higher for VPZ-based triple therapy (88.4% and 93.0%, respectively, per protocol (PP)) than for EPZ-based triple therapy (69.5% and 56.5%, respectively, PP). Moreover, the success rates of first- and third-line eradication of clarithromycin (CLR)- and sitafloxacin (STFX)-resistant H. pylori were significantly higher for VPZ-based triple therapy (72.0% and 91.7%, PP) than for EPZ-based triple therapy (38.5% and 20.0%, PP). In addition, patient age did not affect the eradication rate of VPZ-based first-line therapy, whereas the success rate of EPZ-based therapy was lower in patients under 65 years of age. Our results clearly demonstrated that VPZ-based therapy achieved a higher eradication rate even against CLR- and STFX-resistant H. pylori, and that patient age did not affect the eradication rate of VPZ-based therapy. These findings suggest that dual therapy using VPZ and amoxicillin may be sufficient for standard H. pylori eradication, and may thus also be beneficial for avoiding antibiotic misuse.

scholarly journals Selective killing of Helicobacter pylori with pH-responsive helix–coil conformation transitionable antimicrobial polypeptides

2017 ◽  
Vol 114 (48) ◽  
pp. 12675-12680 ◽  
Author(s):  
Menghua Xiong ◽  
Yan Bao ◽  
Xin Xu ◽  
Hua Wang ◽  
Zhiyuan Han ◽  
...  
Keyword(s):  
Helicobacter Pylori ◽  
Triple Therapy ◽  
Helical Structure ◽  
Commensal Bacteria ◽  
Gastric Ulcers ◽  
Normal Tissues ◽  
Minimal Toxicity ◽  
Antimicrobial Polypeptides ◽  
H Pylori ◽  
Drug Resistant Strains

Current clinical treatment of Helicobacter pylori infection, the main etiological factor in the development of gastritis, gastric ulcers, and gastric carcinoma, requires a combination of at least two antibiotics and one proton pump inhibitor. However, such triple therapy suffers from progressively decreased therapeutic efficacy due to the drug resistance and undesired killing of the commensal bacteria due to poor selectivity. Here, we report the development of antimicrobial polypeptide-based monotherapy, which can specifically kill H. pylori under acidic pH in the stomach while inducing minimal toxicity to commensal bacteria under physiological pH. Specifically, we designed a class of pH-sensitive, helix–coil conformation transitionable antimicrobial polypeptides (HCT-AMPs) (PGA)m-r-(PHLG-MHH)n, bearing randomly distributed negatively charged glutamic acid and positively charged poly(γ-6-N-(methyldihexylammonium)hexyl-l-glutamate) (PHLG-MHH) residues. The HCT-AMPs showed unappreciable toxicity at physiological pH when they adopted random coiled conformation. Under acidic condition in the stomach, they transformed to the helical structure and exhibited potent antibacterial activity against H. pylori, including clinically isolated drug-resistant strains. After oral gavage, the HCT-AMPs afforded comparable H. pylori killing efficacy to the triple-therapy approach while inducing minimal toxicity against normal tissues and commensal bacteria, in comparison with the remarkable killing of commensal bacteria by 65% and 86% in the ileal contents and feces, respectively, following triple therapy. This strategy renders an effective approach to specifically target and kill H. pylori in the stomach while not harming the commensal bacteria/normal tissues.

scholarly journals In Vitro Activity of a Novel Antimicrobial Agent, TG44, for Treatment of Helicobacter pylori Infection

2006 ◽  
Vol 50 (9) ◽  
pp. 3062-3069 ◽  
Author(s):  
Osamu Kamoda ◽  
Kinsei Anzai ◽  
Jun-ichi Mizoguchi ◽  
Masatoshi Shiojiri ◽  
Toshiharu Yanagi ◽  
...  
Keyword(s):  
Helicobacter Pylori ◽  
Antibacterial Activity ◽  
Bactericidal Activity ◽  
Structural Formula ◽  
Therapeutic Modalities ◽  
Resistant Strains ◽  
H Pylori ◽  
Ph Range ◽  
Drug Resistant Strains

ABSTRACT Due to concerns about the current therapeutic modalities for Helicobacter pylori infection, e.g., the increased emergence of drug-resistant strains and the adverse reactions of drugs currently administered, there is a need to develop an anti-H. pylori agent with higher efficacy and less toxicity. The antibacterial activity of TG44, an anti-H. pylori agent with a novel structural formula, against 54 clinical isolates of H. pylori was examined and compared with those of amoxicillin (AMX), clarithromycin (CLR), and metronidazole (MNZ). Consequently, TG44 inhibited the growth of H. pylori in an MIC range of 0.0625 to 1 μg/ml. The MIC ranges of AMX, CLR, and MNZ were 0.0078 to 8 μg/ml, 0.0156 to 64 μg/ml, and 2 to 128 μg/ml, respectively. The antibacterial activity of TG44 against AMX-, CLR-, and MNZ-resistant strains was nearly comparable to that against drug-susceptible ones. In a pH range of 3 to 7, TG44 at 3.13 to 12.5 μg/ml exhibited potent bactericidal activity against H. pylori in the stationary phase of growth as early as 1 h after treatment began, in contrast to AMX, which showed no bactericidal activity at concentrations of up to 50 μg/ml at the same time point of treatment. TG44 at 25 μg/ml exhibited no antibacterial activity against 13 strains of aerobic bacteria, suggesting that its antibacterial activity against H. pylori is potent and highly specific. The present study indicated that TG44 possesses antibacterial activity which manifests quickly and is potentially useful for eradicating not only the antibiotic-susceptible but also the antibiotic-resistant strains of H. pylori by monotherapy.

scholarly journals A study on healing of peptic ulcer disease after eradication of helicobacter pylori infection

2014 ◽  
Vol 43 (2) ◽  
pp. 84-89 ◽  
Author(s):  
Md Razibul Alam ◽  
Ershad Uddin Ahmed ◽  
Md Zahidur Rahman ◽  
ASM Nazmul Islam ◽  
Md Masudur Rahman Khan ◽  
...  
Keyword(s):  
Helicobacter Pylori ◽  
Peptic Ulcer ◽  
Peptic Ulcer Disease ◽  
Triple Therapy ◽  
Ulcer Healing ◽  
Eradication Rate ◽  
Helicobacter Pylori Infection ◽  
Ulcer Disease ◽  
Standard Triple Therapy ◽  
H Pylori

There is intimate connection between peptic ulcer & Helicobacter pylori infection. But some uncertainties still surround the relationship between status of H. pylori infection and extent & time required for ulcer healing. This prospective observational study was carried out in the department of Gastroenterology, BSMMU, Dhaka from January 2007 to January 2008 to determine whether the successful eradication of H. pylori leads to adequate ulcer healing. To see the pattern of endoscopic findings in patients still having H. pylori infection after standard triple therapy for H. pylori were also a objective. Eighty nine consecutive patients, aged 15-60 years and of both genders, coming to the gastroenterology outpatient department with the symptoms suggestive of peptic ulcer disease and dyspepsia were included and H. pylori status was defined as positive if both rapid urease test & histopathology were positive. As found in this study, H. pylori was associated with 90% of duodenal ulcers and 80% of gastric ulcers. H. pylori eradication rate was 69%. Healing rate of duodenal ulcer and gastric ulcer after standard triple therapy for 14 days were 80% and 78% respectively. Adequate ulcer healing was achieved in this study despite relatively low eradication rate. Follow-up for additional period is required for recurrence of ulcer in 84 patients whose peptic ulcer disease had resolved but could not attain H. pylori eradication and H. pylori eradicated patients who are still having ulcer at endoscopy DOI: http://dx.doi.org/10.3329/bmj.v43i2.21388 Bangladesh Med J. 2014 May; 43 (2): 84-89

Effectiveness and Safety of Pylera® in Patients Infected by Helicobacter Pylori: A Multicenter, Retrospective, Real Life Study

2018 ◽  
Vol 36 (4) ◽  
pp. 264-268 ◽  
Author(s):  
Antonio Tursi ◽  
Marilisa Franceschi ◽  
Leonardo Allegretta ◽  
Edoardo Savarino ◽  
Rudi De Bastiani ◽  
...  
Keyword(s):  
Helicobacter Pylori ◽  
Eradication Rate ◽  
Rescue Therapy ◽  
Large Population ◽  
Real Life ◽  
Life Effectiveness ◽  
Life Study ◽  
Intention To Treat ◽  
Previously Treated Patients ◽  
H Pylori

Background: Our aims were to assess the real life effectiveness and safety of the new bismuth-containing quadruple therapy in a large population of patients infected by Helicobacter pylori. Methods: Consecutive dyspeptic H. pylori-positive patients were enrolled, both naïve for treatment and already unsuccessfully treated. Patients were treated with Pylera® 3 capsules 4 times/daily plus omeprazole 20 mg or esomeprazole 40 mg 2 times/daily for 10 days. Eradication was confirmed using a urea-breath test (at least 30 days after the end of the treatment). Efficacy and safety were assessed. Results: A total of 349 patients were treated. H. pylori eradication was achieved in 316 (90.5%, 95% CIs 80.8–1.0) patients in the intention-to-treat population, and in 93.5% (95% CIs 83.5–1.0) in the per-protocol population. No difference in the eradication rate was found between naïve and previously treated patients (91.3 vs. 90.0%, p = 0.901). Adverse events occurred in 55 patients (15.8%, 95% CIs 11.9–20.1). Five patients discontinued treatment: 2 patients suffered from severe abdominal pain, one patient from headache, one patient from diarrhea, and one patient from diffuse urticarial rush. Conclusions: Pylera® achieved a remarkable eradication rate in real life both as first treatment and as a rescue therapy, with a good safety profile.

scholarly journals Efficacy of dexlansoprazole-based triple therapy for Helicobacter pylori infections

2019 ◽  
Vol 12 ◽  
pp. 175628481987096
Author(s):  
Chia-Jung Kuo ◽  
Chun-Wei Chen ◽  
Puo-Hsien Le ◽  
Jun-Te Hsu ◽  
Cheng-Yu Lin ◽  
...  
Keyword(s):  
Helicobacter Pylori ◽  
Triple Therapy ◽  
Breath Test ◽  
Eradication Rate ◽  
Urea Breath Test ◽  
Helicobacter Pylori Eradication ◽  
Treatment Regimens ◽  
Group A ◽  
H Pylori ◽  
Group B

Background: Dexlansoprazole has been shown to be efficacious for the treatment of gastroesophageal reflux disease. However, there is a paucity of data about its efficacy for Helicobacter pylori eradication. The aim of this study was to evaluate the efficacy of dexlansoprazole for H. pylori eradication as triple therapy in real-world practice. Methods: Adult patients with endoscopically proven H. pylori related peptic ulcer diseases or gastritis were recruited for this study. The eradication status was assessed based on the results of the 13C-urea breath test performed 4 weeks after treatment. According to the different treatment regimens, the patients were allocated to group A: Esomeprazole 40 mg b.i.d. + amoxicillin 1 g b.i.d. + clarithromycin 500 mg b.i.d. for 7 days; group B: Esomeprazole 40 mg q.d. + amoxicillin 1 g b.i.d. + clarithromycin 500 mg b.i.d. for 7 days, or group C: Dexlansoprazole 60 mg q.d. + amoxicillin 1 g b.i.d. + clarithromycin 500 mg b.i.d. for 7 days. Results: A total of 215 patients (49% males) were enrolled in this study, with a mean age of 55 years. The eradication rates in group A, B, and C were 94.7% (71/75), 89.6% (69/77), and 93.7% (59/63) ( p = 0.457), respectively. The adverse events were similar between the three groups ( p = 0.068). Conclusions: This study suggests that dexlansoprazole-based triple therapy has an acceptable eradication rate for H. pylori infection.

Dual Therapy with Vonoprazan and Amoxicillin Is as Effective as Triple Therapy with Vonoprazan, Amoxicillin and Clarithromycin for Eradication of Helicobacter pylori

Digestion ◽  
2019 ◽  
Vol 101 (6) ◽  
pp. 743-751 ◽  
Author(s):  
Takahisa Furuta ◽  
Mihoko Yamade ◽  
Takuma Kagami ◽  
Takahiro Uotani ◽  
Takahiro Suzuki ◽  
...  
Keyword(s):  
Helicobacter Pylori ◽  
Triple Therapy ◽  
Eradication Rate ◽  
Antimicrobial Agents ◽  
Eradication Therapy ◽  
Dual Therapy ◽  
Urea Breath Test ◽  
Intention To Treat ◽  
H Pylori ◽  
Treat Analysis

<b><i>Backgrounds/Aims:</i></b> Vonoprazan (VPZ) is the first clinically available potassium competitive acid blocker. This class of agents provides faster and more potent acid inhibition than proton pump inhibitors. Most strains of <i>Helicobacter pylori</i> are sensitive to amoxicillin. We hypothesized that dual therapy with VPZ and amoxicillin would provide the sufficient eradication rate for <i>H. pylori</i> infection. To evaluate this, we compared the eradication rate by the dual VPZ/amoxicillin therapy with that by the standard triple VPZ/amoxicillin/clarithromycin therapy. <b><i>Methods:</i></b> Non-inferiority of the eradication rate of <i>H. pylori</i> by the dual therapy with VPZ 20 mg twice daily (bid) and amoxicillin 500 mg 3 times daily (tid) for 1 week to that by the triple therapy with VPZ 20 mg bid, amoxicillin 750 mg bid and clarithromycin 200 mg bid for 1 week was retrospectively studied. Propensity score matching was performed to improve comparability between 2 regimen groups. Successful eradication was diagnosed using the [<sup>13</sup>C]-urea breath test at 1–2 months after the end of eradication therapy. <b><i>Results:</i></b> The intention-to-treat analysis demonstrated that the eradication rate by the dual therapy (92.9%; 95% CI 82.7–98.0%, 52/56) was not inferior to that of the triple therapy (91.9%; 95% CI 80.4–97.0%, 51/56; OR 1.275, 95% CI 0.324–5.017%, <i>p</i> = 0.728). There were no statistically significant differences in incidences of adverse events between 2 regimens. <b><i>Conclusion:</i></b> VPZ-based dual therapy (VPZ 20 mg bid and amoxicillin 500 mg tid for 1 week) provides an acceptable eradication rate of <i>H. pylori</i> infection without the need for second antimicrobial agents, such as clarithromycin.

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