scholarly journals Is It Time for Quadruple Therapy to be First Line?

2003 ◽  
Vol 17 (suppl b) ◽  
pp. 33B-35B ◽  
Author(s):  
Loren Laine
Keyword(s):  
Triple Therapy ◽  
Randomized Trials ◽  
Eradication Rate ◽  
First Line ◽  
Quadruple Therapy ◽  
First Line Therapy ◽  
Clarithromycin Resistance ◽  
Line Therapy ◽  
Metronidazole Resistance ◽  
H Pylori

The most commonly used regimen forHelicobacter pyloritherapy at present is twice-daily proton pump inhibitor (PPI)-based triple therapy. Bismuth-based therapy is the next most common treatment used by gastroenterologists. When a PPI is combined with bismuth-based triple therapy (quadruple therapy), eradication rates are increased as compared with the triple therapy alone. Three separate randomized trials from three continents that compare quadruple therapy and PPIbased triple therapy revealed remarkably similar results. Eradication rates with PPI-based triple therapy and quadruple therapy were not significantly different. The eradication rates with quadruple therapy were 3% to 6% higher than PPI triple therapy, indicating that quadruple therapy should be no less effective than PPI triple therapy. Furthermore, these two therapies had similar rates of compliance and adverse events.The major potential benefit of the quadruple therapy relates to antibiotic resistance. In patients with clarithromycin resistance, PPIbased triple therapy, but not quadruple therapy, had a significantly lower eradication rate. However, due to its ability to largely overcome metronidazole resistance, quadruple therapy had little if any decrement in eradication rates compared with PPI triple therapy in patients with metronidazole-resistantH pylori. Therefore, quadruple therapy can be considered a first line therapy forH pylori.

EFFICACY OF MODIFIED BISMUTH QUADRUPLE THERAPY (RBMA) AS FIRST-LINE THERAPY FOR ERADICATION OF HELICOBACTER PYLORI IN PATIENTS WITH CHRONIC GASTRITIS

2019 ◽  
pp. 28-32
Author(s):  
Van Huy Tran
Keyword(s):  
Helicobacter Pylori ◽  
Adverse Effects ◽  
Chronic Gastritis ◽  
Eradication Rate ◽  
High Rate ◽  
First Line ◽  
Helicobacter Pylori Eradication ◽  
Quadruple Therapy ◽  
First Line Therapy ◽  
Line Therapy

Background and aims: Efficacy with substitution of tetracycline with amoxicillin, an antibiotics having a very low resistance rate and a high tolerability, in bismuth quadruple therapy (BQT) have not been studied in Vietnam. Our study aimed to evaluate the efficacy and tolerability of modified BQT vs. standard BQT for first-line Helicobacter pylori eradication. Patients and methods: This is a randomized, prospective study. 120 patients with H.pylori positive-chronic gastritis were randomly divided into two groups. The RBMA group containing rabeprazole 20 mg, bismuth subsalicylic 524mg, metronidazole 500mg, amoxicillin 1000mg, all 2 times a day, for 14 days. The RBMT group received rabeprazole, bismuth subsalicylic, metronidazole and tetracycline. Evaluation for compliance and drug-related side effects were evaluated at the end of two weeks. 4-6 weeks after the end of treatment, the H.pylori eradication rate was determined by the C13urease breath test. Results: Eradication rate was not statistically significative different between the RBMA and the RBMT: 91.2%; 95% confidence interval, 78.2% - 96.7%) vs. 90%; 95% CI, 81.6% - 96.3%) by per-protocol analysis (p = 0.42) and 86.7% (95%CI, 75.84% - 93.09%) vs. 75% (95%CI, 62.1% - 85.3%) by intention-to-treat analysis (ITT, p = 0.06). Adverse effects were significant higher in the RBMT group than in the RBMA group (48.3% vs. 26.7%; p = 0.071) and rate of good compliance was significantly higher in RBMA group than in RBMT group (p < 0.05). Conclusion: The modified BQT including rabeprazole, bismuth, metronidazole and amoxicillin achieved a fairly high rate of H.pylori infection eradication with a higher compliance and lower rate of adverse effects compared to the BQT in patients with chronic gastritis. Further studies need to conduct to confirm this new regimens as a first-line therapy in our country. Key words: Modified bismuth quadruple therapy, BQT, Helicobacter pylori eradication

scholarly journals Efficacy of second-line regimens for Helicobacter pylori eradication treatment: a systemic review and network meta-analysis

2020 ◽  
Vol 7 (1) ◽  
pp. e000472 ◽  
Author(s):  
Yen-Lin Chang ◽  
Yu-Chun Tung ◽  
Yu-Kang Tu ◽  
Hong-Zen Yeh ◽  
Jyh-Chin Yang ◽  
...  
Keyword(s):  
Helicobacter Pylori ◽  
Triple Therapy ◽  
Subgroup Analysis ◽  
Meta Analysis ◽  
Eradication Therapy ◽  
Second Line ◽  
First Line ◽  
Quadruple Therapy ◽  
Clarithromycin Resistance ◽  
H Pylori

BackgroundCurrent guidelines recommend bismuth-containing quadruple therapy (BQT) and quinolone-containing therapy after failure of first-line Helicobacter pylori eradication therapy. However, the optimum regimen of second-line eradication therapy remains elusive. We conducted a network meta-analysis to compare the relative efficacy of 16 second-line H. pylori eradication regimens.MethodsThree major bibliographic databases were reviewed to enrol relevant randomised controlled trials between January 2000 and September 2018. Network meta-analysis was conducted by STATA software and we performed subgroup analysis in countries with high clarithromycin resistance and high levofloxacin resistance, and in patients with documented failure of first-line triple therapy.ResultsFifty-four studies totalling 8752 participants who received 16 regimens were eligible for analysis. Compared with a 7-day BQT, use of probiotic add-on therapy during, before, and after second-line antibiotic regimens, quinolone-based sequential therapy for 10–14 days, quinolone-based bismuth quadruple therapy for 10–14 days, bismuth quadruple therapy for 10–14 days, and quinolone-based triple therapy for 10–14 days were significantly superior to the other regimens. Subgroup analysis of countries with high clarithromycin resistance and high levofloxacin resistance revealed that the ranking of second-line eradication regimens was distributed similarly in each group, as well as in patients with failure of first-line triple therapy.ConclusionWe conducted a detailed comparison of second-line H. pylori regimens according to different antibiotic resistance rates and the results suggest alternative treatment choices with potential benefits beyond those that could be achieved using salvage therapies recommended by guidelines.

scholarly journals Seven-Day Nonbismuth Containing Quadruple Therapy Could Achieve a Grade “A” Success Rate for First-LineHelicobacter pyloriEradication

2015 ◽  
Vol 2015 ◽  
pp. 1-7 ◽  
Author(s):  
Wei-Chen Tai ◽  
Chih-Ming Liang ◽  
Chen-Hsiang Lee ◽  
Chien-Hua Chiu ◽  
Ming-Luen Hu ◽  
...  
Keyword(s):  
Therapy Group ◽  
Influential Factor ◽  
Clinical Factors ◽  
First Line ◽  
Quadruple Therapy ◽  
Intention To Treat ◽  
Factors Influencing ◽  
Clarithromycin Resistance ◽  
Metronidazole Resistance ◽  
H Pylori

This prospective study was to assess the efficacy of nonbismuth containing quadruple therapy as first-lineH. pyloritreatment and to determine the clinical factors influencing patient outcome. We enrolled 200H. pylori-infected naïve patients. They were prescribed either a 7-day nonbismuth containing quadruple therapy group (EACM, esomeprazole 40 mg twice daily, amoxicillin 1 g twice daily, metronidazole 500 mg twice daily, and clarithromycin 500 mg twice daily) or a 7-day standard triple therapy group (EAC, esomeprazole 40 mg twice daily, amoxicillin 1 g twice daily, and clarithromycin 500 mg twice daily). Follow-up studies to assess treatment responses were carried out 8 weeks later. The eradication rates attained by EACM and EAC groups were 95.6% (95% confidence interval [CI] = 89.4%–98.3%) and 79.3% (95% CI = 70%–86.4%) in the per-protocol analysis (P< 0.001) and 88% (95% CI = 80.2%–93.0%) and 73% (95% I = 63.6%–80.3%) in the intention-to-treat analysis (P= 0.007). Clarithromycin resistance, metronidazole resistance, and dual clarithromycin and metronidazole resistances were the clinical factors influencingH. pylorieradication in EACM group. Clarithromycin resistance and dual clarithromycin and metronidazole resistances were the influential factor for EAC treatment. In conclusion, the results suggest that 7-day nonbismuth containing quadruple therapy could achieve a grade “A” report card for first-lineH. pyloritreatment.

scholarly journals Eradication Rates of Clarithromycin Triple Therapy in Korea: A Systematic Review and Meta-analysis

2021 ◽  
Vol 21 (1) ◽  
pp. 35-47
Author(s):  
Seung Joo Kang ◽  
Hye-Kyung Jung ◽  
Yong Chan Lee ◽  
Hyo-Joon Yang ◽  
Seon-Young Park ◽  
...  
Keyword(s):  
Triple Therapy ◽  
Eradication Rate ◽  
Meta Analysis ◽  
Random Effect ◽  
Cochrane Library ◽  
First Line ◽  
First Line Therapy ◽  
Line Therapy ◽  
Randomized Controlled Studies ◽  
Standard Triple Therapy

Background/Aims: Standard triple therapy, including a proton pump inhibitor, clarithromycin, and amoxicillin, has been recommended as the first-line for <i>Helicobacter pylori</i> infection. However, the eradication rate of standard triple therapy has declined over the past years because of the increasing resistance to clarithromycin in Korea. We analyzed the eradication rates and the 10-year change in the eradication rates in Korea.Methods: PubMed, EMBASE, the Cochrane Library, and KoreaMed were searched for studies published between January 2007 and June 2018. The pooled eradication rates and their 95% CIs were estimated using a random-effect logistic regression model.Results: Twenty-six randomized controlled studies on standard triple therapy conducted in Korea were selected. The intention-to-treat (ITT) and per protocol analyses showed pooled eradication rates of standard triple therapy of 71.6% (95% CI, 69.9~73.3%) and 79.6% (95% CI, 76.6~82.2%), respectively. The eradication rate decreased with time. The ITT analysis showed that the 14-day therapy (78.1% [95% CI, 75.2~80.7%]) had significantly higher eradication rates than the 7-day therapy (70.0% [95% CI, 68.5~71.4%]) (<i>P</i><0.01).Conclusions: These results suggest that the eradication rate of standard triple therapy, as the first-line therapy, has shown an unacceptable decrease. The eradication rate increased when the duration of therapy was increased to 14 days, but it was not satisfactory. Therefore, other treatment regimens or therapies based on susceptibility tests should be considered for the first-line therapy.

scholarly journals What are the Global Response Rates toHelicobacter pyloriEradication Therapy?

2003 ◽  
Vol 17 (suppl b) ◽  
pp. 25B-29B ◽  
Author(s):  
Christopher Nash ◽  
Lori Fischbach ◽  
Sander Veldhuyzen van Zanten
Keyword(s):  
Triple Therapy ◽  
World Literature ◽  
Success Rates ◽  
Global Response ◽  
Quadruple Therapy ◽  
First Line Therapy ◽  
Line Therapy ◽  
America South ◽  
H Pylori ◽  
Meta Analyses

OBJECTIVE: To perform a systematic review of the world literature to determine current success rates ofHelicobacter pylorieradication treatment.METHODS: Computer searches were performed to identify systematic reviews or meta-analyses of treatment studies ofH pyloriinfection. The searches included specifications for Asia, Africa, North America, South America and Europe.RESULTS: The data supported the current worldwide recommendation to use proton pump inhibitor (PPI)-based triple therapy with clarithromycin and either metronidazole or amoxycillin. There are, however, regional differences in success rates that are not completely explained by resistance to either metronidazole or amoxycillin. For second-line therapy, quadruple therapy using a PPI with bismuth, metronidazole and tetracycline (PPI-BMT) is superior to an alternative PPI-based triple therapy.CONCLUSION: There is worldwide consensus that PPI-based triple therapy, preferably with clarithromycin and amoxycillin or clarithromycin and metronidazole, is used as first-line therapy. Quadruple therapy of PPI-BMT is the preferred rescue medication after initial failure of therapy.

scholarly journals The Optimal First-Line Therapy ofHelicobacter pyloriInfection in Year 2012

2012 ◽  
Vol 2012 ◽  
pp. 1-8 ◽  
Author(s):  
Chao-Hung Kuo ◽  
Fu-Chen Kuo ◽  
Huang-Ming Hu ◽  
Chung-Jung Liu ◽  
Sophie S. W. Wang ◽  
...  
Keyword(s):  
Rescue Therapy ◽  
Treatment Strategies ◽  
Sequential Therapy ◽  
Antibiotics Resistance ◽  
First Line ◽  
First Line Therapy ◽  
Metronidazole Resistance ◽  
Rescue Treatment ◽  
New Treatment ◽  
H Pylori

This paper reviews the literature about first-line therapies forH. pyloriinfection in recent years. First-line therapies are facing a challenge because of increasing treatment failure due to elevated antibiotics resistance. Several new treatment strategies that recently emerged to overcome antibiotic resistance have been surveyed. Alternative first-line therapies include bismuth-containing quadruple therapy, sequential therapy, concomitant therapy, and hybrid therapy. Levofloxacin-based therapy shows impressive efficacy but might be employed as rescue treatment due to rapidly raising resistance. Rifabutin-based therapy is also regarded as a rescue therapy. Several factors including antibiotics resistance, patient compliance, and CYP 2C19 genotypes could influence the outcome. Clinicians should use antibiotics according to local reports. It is recommended that triple therapy should not be used in areas with high clarithromycin resistance or dual clarithromycin and metronidazole resistance.

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 First-line Helicobacter pylori eradication therapies in countries with high and low clarithromycin resistance: a systematic review and network meta-analysis

Gut ◽  
2016 ◽  
Vol 67 (1) ◽  
pp. 20-27 ◽  
Author(s):  
Yee Hui Yeo ◽  
Sz-Iuan Shiu ◽  
Hsiu J Ho ◽  
Biyao Zou ◽  
Jaw-Town Lin ◽  
...  
Keyword(s):  
Helicobacter Pylori ◽  
Triple Therapy ◽  
Eradication Rate ◽  
Random Effect ◽  
Random Effect Model ◽  
Sequential Therapy ◽  
Resistance Rate ◽  
First Line ◽  
Clarithromycin Resistance ◽  
Optimal Regimen

ObjectiveTo determine the optimal regimen of different first-line Helicobacter pylori eradication therapies according to the clarithromycin resistance rate.DesignElectronic search for articles published between January 2005 and April 2016. Randomised, controlled trials that reported the effectiveness of first-line eradication therapies in treatment-naïve adults were included. Two independent reviewers performed articles screening and data extraction. Network and traditional meta-analyses were conducted using the random effect model. Subgroup analyses were performed to determine the ranking of regimens in countries with high (>15%) and low (<15%) clarithromycin resistance. Data including adverse events and therapeutic cure rate were also extracted and analysed.Results117 trials (totally 32 852 patients) for 17 H. pylori eradication regimens were eligible for inclusion. Compared with 7-day clarithromycin-based triple therapy, sequential therapy (ST) for 14 days had the highest effectiveness (OR=3.74, 95% CrI 2.37 to 5.96). ST-14 (OR=6.53, 95% CrI 3.23 to 13.63) and hybrid therapy (HY) for 10 days or more (OR=2.85, 95% CrI 1.58 to 5.37) represented the most effective regimen in areas with high and low clarithromycin resistance, respectively. The effectiveness of standard triple therapy was below therapeutic eradication rate in most of the countries. Longer duration was associated with higher eradication rate, but with a higher risk of events that lead to discontinuation.ConclusionsST and HY appeared to be the most effective therapies in countries with high and low clarithromycin resistance, respectively. The clinical decision for optimal regimen can be supported by referring to the rank ordering of relative efficacies stratified by local eradication rates, antibiotic resistance and safety profile.Trial registration numberCRD42015025445.

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