scholarly journals Transitioning of Helicobacter pylori Therapy from Trial and Error to Antimicrobial Stewardship

Antibiotics ◽  
2020 ◽  
Vol 9 (10) ◽  
pp. 671 ◽  
Author(s):  
David Y. Graham
Keyword(s):  
Helicobacter Pylori ◽  
Antimicrobial Stewardship ◽  
Antimicrobial Therapy ◽  
Treatment Guidelines ◽  
Transition Period ◽  
Current Status ◽  
Trial And Error ◽  
High Cure ◽  
H Pylori ◽  
Cure Rates

Helicobacter pylori is the only major infection for which antimicrobial therapy is not designed using the principles of antimicrobial stewardship. Traditionally, antimicrobial therapy is a susceptibility-based therapy, achieves high cure rates, and includes surveillance programs to regularly provide updated data regarding resistance, outcomes, and treatment guidelines. Current H. pylori therapies identified by trial-and-error, and treatment recommendations and guidelines are based on comparisons among regimens that rarely take into account the prevalence or effect of resistance. The majority of patients currently treated achieve suboptimal results. A paradigm shift is required to abandon current approaches and embrace antimicrobial stewardship, and therefore reliably achieve high cure rates; develop, propagate, and update best practice guidelines; and provide surveillance of local or regional susceptibility/resistance patterns. These also require timely updates to clinicians regarding the current status of resistance, antimicrobial effectiveness, and ways to prevent antimicrobial misuse to extend the useful life of currently available antibiotics. Here, we discuss the differences among current approaches to H. pylori therapy and antimicrobial stewardship and identify what is required to achieve the transition. Conceptually, the differences are significant, and the transition will likely need to be both abrupt and complete. Recommendations for therapy during the transition period are given.

Eradication of Helicobacter pylori: the power of nanosized formulations

Nanomedicine ◽  
2020 ◽  
Vol 15 (5) ◽  
pp. 527-542
Author(s):  
Qianyu Zhang ◽  
Wen Wu ◽  
Jinqiang Zhang ◽  
Xuefeng Xia
Keyword(s):  
Helicobacter Pylori ◽  
Antibiotic Resistance ◽  
Peptic Ulcer ◽  
Gastric Carcinoma ◽  
Antibacterial Agents ◽  
Antimicrobial Agents ◽  
Mucosal Barrier ◽  
Harsh Environment ◽  
H Pylori ◽  
Cure Rates

Helicobacter pylori is a pathogen that is considered to cause several gastric disorders such as chronic gastritis, peptic ulcer and even gastric carcinoma. The current therapeutic regimens mainly constitute of a combination of several antimicrobial agents and proton pump inhibitors. However, the prevalence of antibiotic resistance has been significantly lowering the cure rates over the years. Nanocarriers possess unique strengths in this regard owing to the fact that they can protect the drugs (such as antibiotics) from the harsh environment in the stomach, penetrate the mucosal barrier and deliver drugs to the desired site. In this review we summarized recent studies of different antibacterial agents orally delivered by nanosized carriers for the eradication of H. pylori.

scholarly journals Role of Probiotics in Helicobacter pylori Eradication: Lessons from a Study of Lactobacillus reuteri Strains DSM 17938 and ATCC PTA 6475 (Gastrus®) and a Proton-Pump Inhibitor

2019 ◽  
Vol 2019 ◽  
pp. 1-8 ◽  
Author(s):  
Maria Pina Dore ◽  
Stefano Bibbò ◽  
Giovanni Mario Pes ◽  
Ruggero Francavilla ◽  
David Y. Graham
Keyword(s):  
Helicobacter Pylori ◽  
Lactobacillus Reuteri ◽  
Eradication Therapy ◽  
Cure Rate ◽  
Double Blind ◽  
Antibiotics Use ◽  
Incremental Improvement ◽  
H Pylori ◽  
Meta Analyses ◽  
Cure Rates

Background. Meta-analyses involving >4000 subjects with probiotics added to antimicrobial Helicobacter pylori eradication therapy have reported a mean increase in the eradication rate of 12 to 14%. It is unclear how to translate that result into clinical practice. Aim. To evaluate whether administration of Lactobacillus reuteri plus a PPI without antibiotics would eradicate H. pylori infections. Methods. This was a double-blind placebo-controlled randomized 2-site study of L. reuteri (Gastrus®) at a dose of 2 × 108 CFU, 7 times per day, or matching placebo plus 20 mg pantoprazole b.i.d. for 4 weeks. Cure was defined by negative 13C-UBT, 4 weeks after therapy. Sample size required ≥50% cure rates for using probiotics as a clinically useful monotherapy. Results. Recruitment was halted after 56 subjects because of the low cure rate; there were 8 dropouts; 48 subjects completed therapy (71% women, average age 49 years). The cure rates per protocol were 3/24 (12.5%; 95% CI 2.6–32%) with L. reuteri vs. 1/24 (4.1%) with placebo. Side effects (most often diarrhea) occurred infrequently (in 5/28 vs. 3/28; active vs. placebo therapy) (P=0.53). Conclusion. L. reuteri plus a PPI therapy was unable to provide a clinically important rate of H. pylori eradication. The cure rate albeit low (12.5%) was essentially identical to that achieved when probiotics were added to antibiotic therapy. The incremental improvement was additive and independent of antimicrobial resistance or antibiotics use. Probiotics can reliably increase the cure rate to ≥90% only in regimens achieving cure rates of ∼80%. This trial is registered with NCT03404440.

scholarly journals Helicobacter pylori: Novel Therapies

1999 ◽  
Vol 13 (7) ◽  
pp. 581-583 ◽  
Author(s):  
Eric Drouin
Keyword(s):  
Helicobacter Pylori ◽  
Bacterial Resistance ◽  
Novel Therapies ◽  
In Vitro Activity ◽  
Current Therapies ◽  
H Pylori ◽  
Cure Rates ◽  
Suitable Group ◽  
The Ideal

The ideal therapy forHelicobacter pyloriwould cure the infection without resulting in the development of antibiotic resistance. Current therapies have variable cure rates; the reasons for treatment failure include bacterial resistance and poor compliance. Some antibiotics, such as furazolidone, may be affordable agents to treat this infection worldwide. New proton pump inhibitors, such as rabeprazole, can potentiate antibiotics. Nutriceuticals and probiotics demonstrate interesting in vitro activity againstH pylori. Children rarely have symptoms to this infection and, therefore, are a suitable group in which to assess different nonaggressive therapies.

An optimized clarithromycin-free 14-day triple therapy for Helicobacter pylori eradication achieves high cure rates in Uruguay

2017 ◽  
Vol 40 (7) ◽  
pp. 447-454 ◽  
Author(s):  
Cristina Dacoll ◽  
Jordi Sánchez-Delgado ◽  
Henia Balter ◽  
Ximena Pazos ◽  
María Di Pace ◽  
...  
Keyword(s):  
Helicobacter Pylori ◽  
Triple Therapy ◽  
Helicobacter Pylori Eradication ◽  
High Cure ◽  
Cure Rates

scholarly journals Rifabutin for the Treatment of Helicobacter pylori Infection: A Review

Pathogens ◽  
2020 ◽  
Vol 10 (1) ◽  
pp. 15
Author(s):  
Javier P. Gisbert
Keyword(s):  
Helicobacter Pylori ◽  
Adverse Events ◽  
Resistance Rate ◽  
Helicobacter Pylori Eradication ◽  
Intention To Treat ◽  
Length Of Treatment ◽  
H Pylori ◽  
Cure Rates ◽  
The Ideal

Nowadays, apart from having to know first-line Helicobacter pylori eradication regimens well, we must also be prepared to face treatment failures. The aim of this review is to summarize the role of rifabutin in the management of H. pylori infection. Bibliographical searches were performed in PubMed. Data on resistance and efficacy of rifabutin-containing regimens on H. pylori eradication were meta-analyzed. Mean H. pylori rifabutin resistance rate (39 studies, including 9721 patients) was 0.13%; when studies only including patients naïve to H. pylori eradication treatment were considered, this figure was even lower (0.07%). Mean H. pylori eradication rate (by intention-to-treat) with rifabutin-containing regimens (3052 patients) was 73%. Respective cure rates for second-, third-, fourth- and fifth-line therapies, were 79%, 69%, 69% and 72%. Most studies administered rifabutin 300 mg/day, which seemed to be more effective than 150 mg/day. The ideal length of treatment remains unclear, but 10–12-day regimens are generally recommended. Adverse events to rifabutin treatment in H. pylori studies were relatively infrequent (15%), and severe adverse events were exceptional (myelotoxicity was the most significant, although always reversible). In summary, rifabutin-containing therapy represents an encouraging strategy generally restricted, at present, to patients where previous (usually multiple) eradication regimens have failed.

scholarly journals Cross-roads for meta-analysis and network meta-analysis of H. pylori therapy

Gut ◽  
2021 ◽  
pp. gutjnl-2021-326170
Author(s):  
David Y Graham ◽  
Ruben Hernaez ◽  
Theodore Rokkas
Keyword(s):  
Treatment Guidelines ◽  
Meta Analysis ◽  
Local Population ◽  
Poor Quality ◽  
Phenotypic Heterogeneity ◽  
Progressive Development ◽  
H Pylori ◽  
Randomised Controlled ◽  
Meta Analyses ◽  
Cure Rates

Helicobacter pylori infections are responsible for tremendous morbidity and mortality worldwide, leading to efforts to eradicate the organism. However, the effectiveness of antimicrobial therapy has been undermined by the progressive development of antimicrobial resistance. Treatments and treatment guidelines have been based on traditional pairwise meta-analyses of randomised controlled trials. More recently, network meta-analyses have also been used in an attempt to provide useful information to the clinician regarding which therapies appear best and which to avoid as the least efficacious. However, both forms of meta-analysis have been undermined by the same problems including the poor quality of the clinical trials using unoptimised regimens and incomparable comparisons related to marked geographic and ethnic genotypic and phenotypic heterogeneity. In addition, the comparator regimens often consist of invalid strawman comparisons. New approaches concerning H. pylori treatment and analysis of therapies are needed. H. pylori therapies should be based on antimicrobial stewardship, as in other infectious diseases. This approach requires the use of only optimised therapies proven to be reliably highly effective in the local population (eg, a cure rate of >90%) for both the study and the comparator regimens. Meta-analyses should be restricted to regimens that meet these criteria and must take into account the presence of marked geographical and host genetic and phenotypic heterogeneity. In addition, to provide clinically relevant results, treatment outcomes should focus on, and present, actual cure rates in addition to odd ratios.

scholarly journals An Update of Helicobacter pylori Prevalence and Associated Risk Factors in Southern Iran: A Population-Based Study

2020 ◽  
Vol 23 (10) ◽  
pp. 665-671
Author(s):  
Fateme Ziyaee ◽  
Abdolvahab Alborzi ◽  
Gholamreza Pouladfar ◽  
Bahman Pourabbas ◽  
Sadaf Asaee ◽  
...  
Keyword(s):  
Developing Countries ◽  
Helicobacter Pylori ◽  
Parental Education ◽  
Population Based ◽  
Current Status ◽  
Preventive Strategies ◽  
Prevalence Rates ◽  
Population Based Study ◽  
Southern Iran ◽  
H Pylori

Background: The childhood period is considered to be the primary period for acquisition of the Helicobacter pylori. The high prevalence rates from developing countries are associated with gastric cancer. A decreasing trend of its prevalence has been reported from different parts of the world. Determining the prevalence rate could be important in choosing preventive strategies. This study aimed to determine the prevalence of H. pylori among a group of children from southern Iran to provide an update on the current status of the disease. Methods: This is a cross-sectional population-based study conducted in Shiraz, southern Iran, from January 2014 to December 2015. Four groups including neonates, children aged 6 months to 3 years, 10- and 15-year-old children were included. Multi-monoclonal stool antibody test was used for diagnosis. Results: Among 436 participants, 24.8% (95% CI: 20.8–29.1) had a positive test for H. pylori: 25% in neonates (95% CI: 16.2–36.1), 22% in children aged 6 months to 3 years (95% CI: 15.2–30.2), 19.5% in the 10-year-old (95% CI: 12.3–29.4), and 29.2% in 15-year-old children (95% CI: 21–39). Sex, age, number of siblings, owning a pet, parents’ smoking status, parental education, residential area, birth weight, and feeding status were not found to be statistically significant predictors of H. pylori antigen positivity (P > 0.05). Conclusion: The prevalence of H. pylori was estimated to be low in southern Iran in comparison with previous reports or other developing countries. Preventive strategies with respect to low prevalence rates may be considered in the childhood period.

scholarly journals Changing prevalence of Helicobacter pylori infection in children and adolescents

2021 ◽  
Vol 64 (1) ◽  
pp. 21-25
Author(s):  
Ji Sook Park ◽  
Jin Su Jun ◽  
Ji-Hyun Seo ◽  
Hee-Shang Youn ◽  
Kwang-Ho Rhee
Keyword(s):  
Gastric Cancer ◽  
Helicobacter Pylori ◽  
Children And Adolescents ◽  
Infection Rate ◽  
Later Life ◽  
Current Status ◽  
Literature Reviews ◽  
The Status ◽  
H Pylori ◽  
Global Population

<i>Helicobacter pylori</i> infection has declined over recent decades. However, its prevalence remains high, and nearly 50% of the global population has been infected. In Korea, seroprevalence has steadily decreased in adults, but the status of <i>H. pylori</i> infection in children is unknown. The current status or trend of <i>H. pylori</i> infection in children is important because it can help estimate <i>H. pylori</i>-related diseases including gastric cancer in later life. In this review, the authors discuss the change in <i>H. pylori</i> infection rate among children and adolescents based on literature reviews and our research.

scholarly journals Eradication Therapy Should Be Different for Dyspeptic Patients than for Ulcer Patients

2003 ◽  
Vol 17 (suppl b) ◽  
pp. 41B-45B ◽  
Author(s):  
Wink A de Boer
Keyword(s):  
Helicobacter Pylori ◽  
Peptic Ulcer ◽  
Eradication Therapy ◽  
Cure Rate ◽  
Ulcer Disease ◽  
Biological Explanation ◽  
Choice Of Treatment ◽  
H Pylori ◽  
Different Strains ◽  
Cure Rates

Physicians should try to achieve an optimal cure rate with their initialHelicobacter pylorieradication therapy. Most physicians use the same treatment in all their patients.H pyloriinfection in patients with peptic ulcer disease (PUD) is more likely to be cured than that in patients with functional dyspepsia (FD). Differences in cure rates of 5% to 15% are usually reported, which is considered to be clinically relevant. A plausible biological explanation for this finding suggests that different strains (virulent [cagA+,vacAtype s1] compared with nonvirulent strains [cagA–,vacAtype s2]) in PUD and FD induce different changes in the gastric mucosa, and this facilitates or impairs antimicrobial efficacy. Physicians should be aware that most published treatment studies have included only PUD patients. This means that in clinical practice cure rates obtained in patients with FD or perhaps uninvestigated dyspepsia are usually lower than those reported in the literature. This has implications for the choice of treatment. Physicians should consider prolonging the duration of initialHelicobactereradication therapy from seven to 10 to 14 days in patients without ulcers.

scholarly journals Evaluation of the Effectiveness of Helicobacter pylori Eradication Regimens in Lithuania during the Years 2013–2020: Data from the European Registry on Helicobacter pylori Management (Hp-EuReg)

Medicina ◽  
2021 ◽  
Vol 57 (7) ◽  
pp. 642
Author(s):  
Paulius Jonaitis ◽  
Juozas Kupcinskas ◽  
Olga P. Nyssen ◽  
Ignasi Puig ◽  
Javier P. Gisbert ◽  
...  
Keyword(s):  
Helicobacter Pylori ◽  
Triple Therapy ◽  
Diagnostic Methods ◽  
Line Treatment ◽  
Second Line ◽  
First Line ◽  
Intention To Treat ◽  
H Pylori ◽  
Cure Rates ◽  
European Registry

Background and Objectives: The prevalence of H. pylori in Eastern Europe remains quite high; however, there is insufficient data on the eradication regimens and their effectiveness. Therefore, the objective of the study was to evaluate the diagnostic methods and treatment of H. pylori infection as well as their adherence to Maastricht V/Florence consensus during the years 2013–2020 in Lithuania. Materials and Methods: Sub-study of the “European Registry on H. pylori Management” (Hp-EuReg), international multicenter prospective non-interventional registry of the routine clinical practice. Lithuanian data from the years 2013–2020 were analyzed for effectiveness on a modified intention-to-treat (mITT) basis. 2000 adult patients, diagnosed with H. pylori infection, were included. Data were compared to the European Maastricht V guidelines. Results: Triple-therapy was used in 90% of the cases. In 91% of the first-line prescriptions, standard triple therapy (STT) was used. The most common second-line treatment was a combination of PPI, amoxicillin and levofloxacin (PPI+A+L) (47%). The overall effectiveness in 552 cases valid for analysis was 90% by mITT. In first-line treatment, the STT effectiveness was 90% and second-line treatment with PPI+A+L achieved 92% by mITT. Increasing overall H. pylori eradication rates were observed: from 72% in 2013 to more than 90% in 2018–2020, as well as a shift from 7 to 10–14 days treatments duration throughout 2013–2020. Conclusions: In Lithuania, the prescribed eradication regimens for H. pylori were in accordance with the international guidelines but diagnostic methods and treatment duration only partially met Maastricht V/Florence guidelines. The eradication effectiveness was improved progressively during the years 2018–2020, reaching ≥90% cure rates.

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