scholarly journals Bismuth based quadruple therapy versus Concomitant therapy for H. Pylori eradication –a real‐world experience

GastroHep ◽  
2021 ◽  
Author(s):  
David Mathew Thomas ◽  
Krishnadas Devadas
Keyword(s):  
Real World ◽  
Concomitant Therapy ◽  
Quadruple Therapy ◽  
H Pylori

scholarly journals The efficacy and safety of quadruple therapy without bismuth (concomitant therapy) in the treatment of patients with Helicobacter pylori - associated gastric and duodenal peptic ulcer disease

2019 ◽  
Vol 91 (8) ◽  
pp. 28-33 ◽  
Author(s):  
A M Veliev ◽  
I V Maev ◽  
D N Andreev ◽  
D T Dicheva ◽  
A V Zaborovskii ◽  
...  
Keyword(s):  
Duodenal Ulcer ◽  
Helicobacter Pylori ◽  
Side Effects ◽  
Triple Therapy ◽  
Eradication Therapy ◽  
Test System ◽  
Efficacy And Safety ◽  
Concomitant Therapy ◽  
Quadruple Therapy ◽  
H Pylori

Aim. Evaluation of the efficacy and safety of quadrupletherapy without bismuth (concomitant therapy) in patients with Helicobacter pylori - associated gastric ulcer and duodenal ulcer in the framework of a comparative research in the population of patients in Russia. Materials and methods. A prospective randomized trial was conducted, which included 210 patients with H. pylori - associated gastric/duodenal ulcer without complications. During the process of randomization, the patients were divided into three equal groups (n=70) depending on the prescribed 10-day scheme of eradication therapy (ET): the first group received the classic triple scheme (Omeprazole 20 mg 2 times a day, Amoxicillin 1000 mg 2 times a day and Clarithromycin 500 mg 2 times a day); the second group received quadruple therapy with bismuth drugs (Omeprazole 20 mg 2 times a day, Tetracycline 500 mg 4 times a day, Metronidazole 500 mg 3 times a day, Bismuth subcitrate potassium 120 mg 4 times a day); the third group received quadruple therapy without bismuth - concomitant therapy (Omeprazole 20 mg 2 times a day, Amoxicillin 1000 mg 2 times a day, Clarithromycin 500 mg 2 times a day and Metronidazole 500 mg 2 times a day). Diagnostics of H. pylori infection during screening and control of eradication was carried out via the fast urease biopsy sample test and urea breath test system. Control of the effectiveness of ET of the microorganism was carried out not earlier than 4 weeks after the end of the treatment. During the course of therapy, the frequency of development of side effects was assessed using a special questionnaire. Results and discussion. The effectiveness of triple therapy was 72.8% (ITT; 95% CI of 62.17-83.54) and 78,4% (PP; 95% CI 68.19-88.72); quadruple therapy with the preparation of bismuth - 80.0% (ITT; 95% CI 70.39-89.6) and 84,8% (PP; 95% CI, 75.96-93.73); quadruple therapy without bismuth - concomitant therapy - 84.2% (ITT; 95% CI 75.54-93.02) and 92.1% (PP; 95% CI 85.43-98.94). Quadruple therapy without bismuth was reliably more effective than the classical triple therapy in the PP selection (p=0.044883). Statistical analysis showed a tendency to poorer effectiveness of ET in patients who had previously used antibiotic therapy (OR 0.4317; 95% CI 0.1776-1.049), and in individuals with a rapid metabolism genotype - CYP2C19*1/*1 (OR 0.12; 95% CI 0.005848-2.4624). The frequency of development of side effects during the use of triple therapy was 18.5% (95% CI of 9.23-27.91), when using quadruple therapy with bismuth - 20.0% (95% CI 10.39-29.6), and with the use of quadruple therapy without bismuth - concomitant therapy - 24.2% (95% CI 13.98-34.58). Conclusion. This prospective randomized study demonstrated the high efficiency of quadruple therapy without bismuth (concomitant therapy) in the framework of eradication of H. pylori infection in Russia.

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 Helicobacter  pyloriEradication Therapies in the Era of Increasing Antibiotic Resistance: A Paradigm Shift to Improved Efficacy

2012 ◽  
Vol 2012 ◽  
pp. 1-9 ◽  
Author(s):  
Sotirios D. Georgopoulos ◽  
Vasilios Papastergiou ◽  
Stylianos Karatapanis
Keyword(s):  
Paradigm Shift ◽  
Sequential Therapy ◽  
Concomitant Therapy ◽  
First Line ◽  
Quadruple Therapy ◽  
Bacterial Infectious Disease ◽  
Critical Issues ◽  
H Pylori ◽  
Cure Rates ◽  
Near Future

With the rising prevalence of antimicrobial resistance, the eradication rates ofHelicobacter pylori (H. pylori)with standard treatments are decreasing to unacceptable levels (i.e., ≤80%) in most countries. After these disappointing results, several authorities have proposed that infection withH. pylorishould be approached and treated as any other bacterial infectious disease. This implicates that clinicians should prescribe empirical treatments yielding a per protocol eradication of at least 90%. In recent years several treatments producing ≥90% cure rates have been proposed including sequential therapy, concomitant quadruple therapy, hybrid (dual-concomitant) therapy, and bismuth-containing quadruple therapy. These treatments are likely to represent the recommended first-line treatments in the near future. In the present paper, we are considering a series of critical issues regarding currently available means and approaches for the management ofH. pyloriinfection. Clinical needs and realistic endpoints are taken into account. Furthermore, emerging strategies for the eradication ofH. pyloriand the existing evidence of their clinical validation and widespread applicability are discussed.

EVALUATION OF HELICOBACTER PYLORI RESISTANCE TO CLARITHROMYCIN AND LEVOFLOXACIN BY EPSILOMETER TEST IN DONG NAI PROVINCE, 2013

2014 ◽  
pp. 12-18
Author(s):  
Ngoc Quy Hue Dang ◽  
Van Huy Tran ◽  
Si Tuan Nguyen ◽  
Nguyen Dang Khoa Le ◽  
Thi Minh Thi Nguyen ◽  
...  
Keyword(s):  
Helicobacter Pylori ◽  
Resistance Rate ◽  
Concomitant Therapy ◽  
Secondary Resistance ◽  
Quadruple Therapy ◽  
Sensitivity Rate ◽  
The Mean ◽  
H Pylori ◽  
Mean Time ◽  
Main Factor

Background: Regimens with Clarithromycin-based and Levofloxacin-based triple were standard treatments for H.pylori eradication, but the increased prevalence of H.pylori strains resistant to Clarithromycin (CLA) and Levofloxacin (LEV) had became the main factor for treatment failure. Aims: to determine the rate of H. pylori isolates in culture and antibiogram using Epsilometer (Etest) with CLA and LEV done successfully in patients who have positive CLO test; to determine the prevalence of primary and secondary resistance of H. pylori to CLA and LEV. Materials and methods: 60 patients who presenting with gastroduodenal diseases at Thong Nhat-Dong Nai Hospital, from 11/2013 to 12/2013, with CLO test positive, were recruited to the study. H.pylori isolates were cultured with PYL medium, then antibiogram against CLA and LEV done by Epsilometer test (Etest) method with Muller Hinton Agar. Results: the rate of successful culture of H.pylori isolates was 91.7%; the mean time for H.pylori growth was 4.0±1.2 days (3-10 days), of these, 81.8% growing in 3-4 days; the successful rate of antibiograms was 89,1%; the rate of primary and secondary resistance to CLA and LEV were 64.1-100% and 29.2-100% respectively; sensitivity rate and resistance rate to both kinds of antibiotics were 20.4% and 22.4%. Conclusions: We should not choose the CLA-based and LEV-based triple therapies in treatment for patients infected with H.pylori in Dong Nai province, except when having sensitive evidence; rather, we should choose Bismuth-based quadruple therapy or use CLA with a different usage such as sequential or concomitant therapy. Key words: H.pylori, antibiotic resistance, primary culture, antibiogram

STUDY ON EFFICACY OF QUADRUPLE THERAPY RACM IN PATIENTS WITH HP- POSITIVE GASTRIC ULCER

2011 ◽  
pp. 88-99
Author(s):  
Khanh Vinh ◽  
Ngoc Doanh Pham ◽  
Van Huy Tran
Keyword(s):  
Gastric Ulcer ◽  
Adverse Effects ◽  
The Other ◽  
Healing Ulcer ◽  
Treatment Results ◽  
Quadruple Therapy ◽  
Ulcer Relapse ◽  
H Pylori ◽  
Chronis Disease ◽  
Positive Materials

Objectives: Gastric ulcer is a chronis disease with a lot of dangerous complications and H. pylori is a major cause of gastric ulcer. Eradicating H. pylori helps reducing ulcer relapse and preventing cancer. The aim of study: to evaluate the rate of H. pylori infection in gastric ulcer and efficacy of quadruple therapy RACM for 5 days in patients with gastric ulcer with H. pylori positive. Materials and methods: Total 98 patients with gastric ulcer have been performed the endoscopy and CLO-Test, treated with quadruple therapy RACM for 5 days and evaluate efficacy 4 weeks after ending treatment. Results: The rate of H. pylori in gastric ulcer is 82.65%. The rate of H. pylori eradication is 88.71%. The effect of reducing pain of therapy is 90.32%; and the rate of reducing pain: 96.37% in successfully H. pylori-eradicated group and in the other group 42.85% (p < 0.05). The effect of healing ulcer of therapy is 77.41%; and the rate of healing gastric ulcer: 83.63% in successfully H. pylori-eradicated group and in the other group 28.57% (p < 0.05). The adverse effects of therapy included tiredness: 11.29%, lose appetite: 8.06% and diarrhea: 6.45%. Conclutions: Quadruple therapy RACM for 5 days showed an effective, safe and simple regime for eradicating H. pylori and should be considered to apply as the first lines treatment for H. pylori.

P.1.123: LEVOFLOXACIN-CONTAINING QUADRUPLE CONCOMITANT THERAPY FOR ERADICATION OF H PYLORI INFECTION

2011 ◽  
Vol 43 ◽  
pp. S188-S189
Author(s):  
A.G. Gravina ◽  
A. Miranda ◽  
F. Micera ◽  
R. Zagaria ◽  
D. Napoletano ◽  
...  
Keyword(s):  
Concomitant Therapy ◽  
H Pylori

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.

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