scholarly journals Helicobacter pyloriInfection: Is Sequential Therapy Superior to Standard Triple Therapy? A Single-Centre Italian Study in Treatment-Naive and Non-Treatment-Naive Patients

2011 ◽  
Vol 25 (6) ◽  
pp. 315-318 ◽  
Author(s):  
R Urgesi ◽  
G Pelecca ◽  
R Cianci ◽  
A Masini ◽  
C Zampaletta ◽  
...  
Keyword(s):  
Triple Therapy ◽  
Breath Test ◽  
Sequential Therapy ◽  
Urea Breath Test ◽  
First Line ◽  
Randomized Controlled ◽  
Standard Triple Therapy ◽  
End Of Treatment ◽  
Treatment Naïve ◽  
H Pylori

BACKGROUND: Clarithromycin resistance has decreased the eradication rates ofHelicobacter pylori.AIMS: To determine whether a 10-day course of sequential therapy (ST) is more effective at eradicatingH pyloriinfection than triple therapy (TT) in the first or second line, and to assess side effects and compliance with therapy.METHODS: One hundred sixty treatment-naive and 40 non-treatment-naive patients who were positive forH pyloriinfection by13C-urea breath test or endoscopy were enrolled. Eighty of 160 patients underwent TT, while 80 of 160 underwent ST with omeprazole (20 mg) plus amoxicillin (1 g) twice/day for five days, followed by omeprazole (20 mg) with tinidazole (500 mg) twice/day and clarithromycin (500 mg) twice/day for five consecutive days.H pylorieradication was evaluated by13C-urea breath test no sooner than four weeks after the end of treatment.RESULTS: Eradication was achieved in 59 of 80 treatment-naive patients treated with TT (74%), in 74 of 80 patients treated with ST (93%), and in 38 of 40 non-treatment-naive patients (95%). Eradication rates in treatment-naive patients with ST were statistically significantly higher than TT (92.5% versus 73.7%; P=0.0015; OR 4.39 [95% CI 1.66 to 11.58]). Mild adverse effects were reported for both regimens.CONCLUSIONS: ST appears to be a well-tolerated, promising therapy; however, randomized controlled trials with larger and more diverse sample populations are needed before it can be recommended as a first-line treatment.

scholarly journals A Randomized Controlled Trial Comparing Sequential with Triple Therapy forHelicobacter pyloriin an Aboriginal Community in the Canadian North

2013 ◽  
Vol 27 (12) ◽  
pp. 701-706 ◽  
Author(s):  
Amy L Morse ◽  
Karen J Goodman ◽  
Rachel Munday ◽  
Hsiu-Ju Chang ◽  
John Morse ◽  
...  
Keyword(s):  
Triple Therapy ◽  
Treatment Effectiveness ◽  
Controlled Trial ◽  
Alternative Therapy ◽  
Sequential Therapy ◽  
Aboriginal Community ◽  
Intention To Treat ◽  
Standard Triple Therapy ◽  
Treatment Naïve ◽  
H Pylori

BACKGROUND:Helicobacter pyloriinfection occurs more frequently in Arctic Aboriginal settings than elsewhere in North America and Europe. Research aimed at reducing health risks fromH pyloriinfection has been conducted in the Aboriginal community of Aklavik, Northwest Territories.OBJECTIVE: To compare the effectiveness of the Canadian standard therapy with an alternative therapy for eliminatingH pyloriinfection in Aklavik.METHODS: Treatment-naiveH pylori-positive individuals were randomly assigned to a 10-day regimen (oral twice-daily doses) with rabeprazole (20 mg): standard triple therapy (proton pump inhibitor, added clarithromycin [500 mg] and amoxicillin [1 g] [PPI-CA]); sequential therapy (ST) added amoxicillin (1 g) on days 1 to 5, and metronidazole (500 mg) and clarithromycin (500 mg) on days 6 to 10. Participants with clarithromycin-resistantH pyloriwere randomly assigned to ST or quadruple therapy. Treatment effectiveness was estimated as per cent (95% CI) with a negative urea breath test at least 10 weeks after treatment.RESULTS: Of 104 (53 PPI-CA, 51 ST) randomized participants, 89 (49 PPI-CA, 40 ST) had post-treatment results. Per-protocol treatment effectiveness was 59% (95% CI 45% to 73%) for PPI-CA and 73% (95% CI 58% to 87%) for ST. Based on intention to treat, effectiveness was 55% (95% CI 41% to 69%) for PPI-CA and 57% (95% CI 43% to 71%) for ST. Of 77 participants (43 PPI-CA, 34 ST) with 100% adherence, effectiveness was 63% (95% CI 43% to 82%) for PPI-CA and 81% (95% CI 63% to 99%) for ST.CONCLUSIONS: While additional evidence is needed to confirm that ST is more effective for Arctic Aboriginal communities than the Canadian standardH pyloritreatment, these results show standard PPI-CA treatment to be inadequate for communities such as Aklavik.

scholarly journals CURRENT DEVELOPMENT OF HELICOBACTER PYLORI ERADICATION PROTOCOLS

2021 ◽  
Author(s):  
A. Pozdeeva ◽  
O. Pozdeev ◽  
G. Gulyaev ◽  
Yu. Valeeva ◽  
A. Savinova
Keyword(s):  
Helicobacter Pylori ◽  
Triple Therapy ◽  
High Efficiency ◽  
Eradication Therapy ◽  
Sequential Therapy ◽  
New Drugs ◽  
Antibacterial Drug ◽  
First Line ◽  
Standard Triple Therapy ◽  
H Pylori

Helicobacter pylori is one of the most common commensal microorganisms in the human body, colonizing up to 60% of the inhabitants on all continents. Some H. pylori strains have acquired virulent properties and their presence can significantly complicate the course of type B atrophic gastritis, gastric ulcer and duodenal ulcer, as well as gastric malignant diseases. In such situations, eradication therapy seems to be pathogenetically justified. In 1996, there were proposed the International Recommendations for standard first-line 7–10-day course triple eradication therapy, including a proton pump inhibitor (PPI), amoxicillin and clarithromycin. Until the beginning of the XXIth century, the International Recommendations has been actively and highly efficiently (up to 90%) used everywhere, but later reports started to emerge regarding a catastrophic decrease in therapeutic outcome (up to 60%). Later, it turned out that the effectiveness of the three-component (triple) therapy directly correlates with the resistance to clarithromycin substantially increased in recent decades, which necessitated generation of new schemes for H. pylori elimination. The results of various schemes for H. pylori eradication were analyzed, including variants of modified triple therapy associated with the inclusion of new drugs or prolonged duration of the therapeutic protocol. In particular, it was proposed to replace amoxicillin with metronidazole. However, further studies have shown that the combination of clarithromycin with amoxicillin seems to be preferable due to the high level of H. pylori resistance to metronidazole recorded in many countries. Attempts to use probiotics in parallel, particularly cultures of various Lactobacillus species, were analyzed, which increases the level of eradication during standard triple therapy from 61.5% to 81.6%, and significantly reduces the severity of side effects. It has been shown that a promising approach to increase the effectiveness of 7-day first-line therapy schemes with clarithromycin is to use modern effective PPIs (for example, esomeprazole or rabeprazole). The scheme of modified sequential therapy with the replacement of clarithromycin with tetracycline or levofloxacin, which has shown high efficiency has been considered. A variant of standard triple therapy modified into quadrotherapy by adding metronidazole or tinidazole was analyzed. It has been shown that the sequential therapy scheme is ineffective for eradication of multidrug-resistant strains. Ideally, the treatment of bacterial infections should be based on endoscopic sampling of gastric mucosa biopsies, followed by microbiological determination of in vitro antibacterial drug sensitivity in bacterial isolates.

scholarly journals Standard Triple Therapy versus Sequential Therapy inHelicobacter pyloriEradication: A Double-Blind, Randomized, and Controlled Trial

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Jaime Natan Eisig ◽  
Tomás Navarro-Rodriguez ◽  
Ana Cristina Sá Teixeira ◽  
Fernando Marcuz Silva ◽  
Rejane Mattar ◽  
...  
Keyword(s):  
Triple Therapy ◽  
Controlled Trial ◽  
Sequential Therapy ◽  
Rapid Urease Test ◽  
Double Blind ◽  
Intention To Treat ◽  
Standard Triple Therapy ◽  
Urease Test ◽  
H Pylori ◽  
Triple Treatment

Aim. To compare 10-day standard triple therapy versus sequential therapy as first-line treatment in patients infected withH. pylori.Methods. One hundredH. pyloripositive patients (diagnosed by rapid urease test and histology), with average age of 47.2, M/F = 28/72, were randomized to receive either standard triple treatment (TT) as follows: lansoprazole 30 mg, clarithromycin 500 mg, and amoxicillin 1 g, b.i.d. for ten days, or sequential treatment (ST) as follows: lansoprazole 30 mg, amoxicillin and placebo 1.0 g b.i.d for the first five days, followed by lansoprazole 30 mg, clarithromycin 500 mg, and tinidazole 500 mg b.i.d, for the remaining five days. Eradication rates were determined 60 days after treatment by urease, histology, or13C-urea breath test.Results. In intention to treat (ITT) analysis, the rate ofH. pylorieradication in the TT and ST groups was the same for both regimens as follows: 86% (43/50), 95% CI 93,3 to 73.4%. In Per protocol (PP) analysis, the rate ofH. pylorieradication in the TT and ST groups was 87.8% (43/49), 95% CI 94,5 to 75.3% and 89.6% (43/48), 95% CI 95,8 to 77.3%, respectively.Conclusions. In Brazil, standard triple therapy is as equally effective as sequential therapy in eradicatingHelicobacter pyloripatients. This study was registered under Clinical Trials with numberISRCTN62400496.

scholarly journals A 14-Day Course of Triple Therapy is Superior to a 10-Day Course for the Eradication ofHelicobacter pylori: A Canadian Study Conducted in a ‘Real World’ Setting

2015 ◽  
Vol 29 (8) ◽  
pp. e7-e10 ◽  
Author(s):  
Yen-I Chen ◽  
Carlo A Fallone
Keyword(s):  
Triple Therapy ◽  
Eradication Rate ◽  
Day Treatment ◽  
Office Visit ◽  
First Line ◽  
Intention To Treat ◽  
Treatment Naïve ◽  
Gastric Biopsies ◽  
H Pylori ◽  
Treat Analysis

BACKGROUND: SuccessfulHelicobacter pylorieradication with the traditional seven-day course of proton pump inhibitor (PPI) triple therapy is declining. Prolonging therapy to either 10 or 14 days is associated with better eradications rates.OBJECTIVE: To compare the effectiveness of 14-day course of triple therapy versus a 10-day course in the treatment ofH pyloriin Canada.METHODS: Consecutive treatment-naive patients with clinical indications forH pylorieradication underwent either a 10-day course or a 14-day course of traditional PPI triple therapy depending on the date of the office visit (an odd date received the 10-day course, whereas an even date received the 14-day treatment).H pylorieradication was ascertained via urea breath test or gastric biopsies performed ≥4 weeks after completion of therapy. Analyses were by both intention to treat and per-protocol.RESULTS: A total of 83 patients were included in the study (31 in the 10-day group and 52 in the 14-day group). In the intention-to-treat analysis, eradication rates were 82.7% (95% CI 70% to 92%) versus 45.2% (95% CI 27% to 64%), favouring the 14-day treatment (P<0.001). Similarly, in the per-protocol analysis, eradication rates were 91.5% (95% CI 80% to 98%) versus 63.6% (95% CI 41% to 83%), favouring the 14-day arm (P=0.01). Adverse events and compliance were not significantly different between the two groups.CONCLUSION: A 14-day course of standard PPI triple therapy was superior to a shorter-duration therapy and should be included as a first-line regimen forH pylorieradication in Canada. The 10-day course of treatment did not achieve an acceptable eradication rate and should no longer be used in this country.

scholarly journals Helicobacter pyloriEradication with Either Seven-Day or 10-Day Triple Therapies, and with a 10-Day Sequential Regimen

2006 ◽  
Vol 20 (2) ◽  
pp. 113-117 ◽  
Author(s):  
Giuseppe Scaccianoce ◽  
Cesare Hassan ◽  
Alba Panarese ◽  
Donato Piglionica ◽  
Sergio Morini ◽  
...  
Keyword(s):  
Triple Therapy ◽  
Breath Test ◽  
Eradication Rate ◽  
Urea Breath Test ◽  
Cure Rate ◽  
Intention To Treat ◽  
Significant Difference ◽  
Sequential Regimen ◽  
H Pylori ◽  
Very High

BACKGROUND:Helicobacter pylorieradication rates achieved by standard seven-day triple therapies are decreasing in several countries, while a novel 10-day sequential regimen has achieved a very high success rate. A longer 10-day triple therapy, similar to the sequential regimen, was tested to see whether it could achieve a better infection cure rate.METHODS: Patients with nonulcer dyspepsia andH pyloriinfection were randomly assigned to one of the following three therapies: esomeprazole 20 mg, clarithromycin 500 mg and amoxycillin 1 g for seven days or 10 days, or a 10-day sequential regimen including esomeprazole 20 mg plus amoxycillin 1 g for five days and esomeprazole 20 mg, clarithromycin 500 mg and tinidazole 500 mg for the remaining five days. All drugs were given twice daily.H pylorieradication was checked four to six weeks after treatment by using a13C-urea breath test.RESULTS: Overall, 213 patients were enrolled.H pylorieradication was achieved in 75.7% and 77.9%, in 81.7% and 84.1%, and in 94.4% and 97.1% of patients following seven-day or 10-day triple therapy and the 10-day sequential regimen, at intention-to-treat and per protocol analyses, respectively. The eradication rate following the sequential regimen was higher than either seven-day (P=0.002) or 10-day triple therapy (P=0.02), while no significant difference emerged between the latter two regimens (P=0.6).CONCLUSIONS: The 10-day sequential regimen was significantly more effective than both triple regimens, while 10-day triple therapy failed to significantly increase theH pylorieradication rate achieved by the standard seven-day regimen.

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