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 Rescue Therapy forHelicobacter pyloriInfection 2012

2012 ◽  
Vol 2012 ◽  
pp. 1-12 ◽  
Author(s):  
Javier P. Gisbert
Keyword(s):  
Rescue Therapy ◽  
Gastroduodenal Ulcer ◽  
Primary Therapy ◽  
First Line ◽  
Quadruple Therapy ◽  
Ulcer Disease ◽  
Rescue Treatment ◽  
Third Line ◽  
H Pylori ◽  
Almost All

Helicobacter pyloriinfection is the main cause of gastritis, gastroduodenal ulcer disease, and gastric cancer. After 30 years of experience inH. pyloritreatment, however, the ideal regimen to treat this infection has still to be found. Nowadays, apart from having to know well first-line eradication regimens, we must also be prepared to face treatment failures. In designing a treatment strategy, we should not only focus on the results of primary therapy alone but also on the final—overall—eradication rate. The choice of a “rescue” treatment depends on which treatment is used initially. If a first-line clarithromycin-based regimen was used, a second-line metronidazole-based treatment (quadruple therapy) may be used afterwards, and then a levofloxacin-based combination would be a third-line “rescue” option. Alternatively, it has recently been suggested that levofloxacin-based “rescue” therapy constitutes an encouraging 2nd-line strategy, representing an alternative to quadruple therapy in patients with previous PPI-clarithromycin-amoxicillin failure, with the advantage of efficacy, simplicity and safety. In this case, quadruple regimen may be reserved as a 3rd-line “rescue” option. Even after two consecutive failures, several studies have demonstrated thatH. pylorieradication can finally be achieved in almost all patients if several “rescue” therapies are consecutively given.

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.

P.01.21 H. PYLORI RESISTANCE STATUS AND EFFICACY OF SEQUENTIAL THERAPY FOR FIRST-LINE THERAPY: A 6-YEAR EXPERIENCE IN A SINGLE ITALIAN CENTER

2018 ◽  
Vol 50 (2) ◽  
pp. e128
Author(s):  
G. Fiorini ◽  
A. Zullo ◽  
I.M. Saracino ◽  
L. Gatta ◽  
M. Pavoni ◽  
...  
Keyword(s):  
Sequential Therapy ◽  
First Line ◽  
First Line Therapy ◽  
Line Therapy ◽  
H Pylori

scholarly journals Sequential Therapy for First-Line Helicobacter pylori Eradication: 10- or 14-Day Regimen?

2019 ◽  
Vol 28 (1) ◽  
pp. 11-14 ◽  
Author(s):  
Angelo Zullo ◽  
Giulia Fiorini ◽  
Giuseppe Scaccianoce ◽  
Piero Portincasa ◽  
Vincenzo De Francesco ◽  
...  
Keyword(s):  
Helicobacter Pylori ◽  
Previous Treatment ◽  
Sequential Therapy ◽  
Bacterial Eradication ◽  
First Line ◽  
Open Label ◽  
Intention To Treat ◽  
First Line Therapy ◽  
13C Urea Breath Test ◽  
H Pylori

Background & Aim: Standard 10-day sequential therapy is advised as first-line therapy for Helicobacter pylori (H. pylori) eradication by current Italian guidelines. Some data suggested that a 14-day regimen may achieve higher eradication rates. This study compared the efficacy of sequential therapy administered for either 10- or 14-days.Methods: This prospective, multicenter, open-label study enrolled patients with H. pylori infection without previous treatment. Patients were receiving a sequential therapy for either 10 or 14 days with esomeprazole 40 mg and amoxicillin 1 g (5 or 7 days) followed by esomeprazole 40 mg, clarithromycin 500 mg and tinidazole 500 mg (5 or 7 days), all given twice daily. Bacterial eradication was checked using 13C-urea breath test. Eradication cure rates were calculated at both Intention-to-treat (ITT) and per-protocol (PP) analyses.Results: A total of 291 patients were enrolled, including 146 patients in 10-day and 145 in the 14-day regimen. The eradication rates were 87% (95% CI = 81.5-92.4) and 90.3% (95% CI = 85.5-95.1) at ITT analysis with the 10- and 14-day regimen, respectively, and 92.7% (95% CI = 88.3-97) and 97% (95% CI = 94.2-99.9) at PP analysis (p =0.37). Among patients, who earlier had interrupted therapy, bacterial eradication was achieved in 8 out of 9 who completed the first therapy phase and performed at least ≥3 days of triple therapy in the second phase.Conclusion: This study found that both 10- and 14-day sequential therapies achieved a high eradication rate for first-line H. pylori therapy in clinical practice.

scholarly journals Comparing the Efficacy of Concomitant Therapy with Sequential Therapy as the First-Line Therapy ofHelicobacter pyloriEradication

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
Sung Min Jung ◽  
Dae Young Cheung ◽  
Jin Il Kim ◽  
Il Kim ◽  
Hyeonjin Seong
Keyword(s):  
Statistical Difference ◽  
Sequential Therapy ◽  
Concomitant Therapy ◽  
First Line ◽  
First Line Therapy ◽  
Line Therapy ◽  
Standard Triple Therapy ◽  
Sequential Group ◽  
13C Urea Breath Test ◽  
H Pylori

Background. The decline ofHelicobacter pylori(H. pylori) eradication rates with standard triple therapy resulted in a search for novel therapies for first-line therapy ofH. pyloriinfection.Aim. The aim of the study is to compare the efficacy of concomitant therapy with sequential therapy as the first-line therapy ofH. pylorieradication.Methods. We reviewed medical records of patients who were confirmed to haveH. pyloriinfection and received eradication treatment from September 2012 to March 2015. The concomitant group was treated with rabeprazole, amoxicillin, clarithromycin, and metronidazole for 7 days. The sequential group was treated with rabeprazole and amoxicillin for 5 days and then rabeprazole, clarithromycin, and metronidazole for an additional 5 days. Six weeks after the treatment period, patients in both groups underwent 13C-Urea breath test (UBT) to confirmH. pylorieradication.Results. The eradication rate was 90.3% in the concomitant group and 85.5% in the sequential group. However, the eradication rates between the two groups showed no statistical difference (P=0.343).Conclusion. No statistical difference was found in eradication rates between the two groups. However, in areas where antibiotic resistance is high, concomitant therapy may be more effective than sequential therapy forH. pylorieradication.

scholarly journals Safety and Efficacy of Mechanical Thrombectomy Using Tigertriever as a Rescue Device After Failed Aspiration—Single Center Experience

2021 ◽  
Vol 11 ◽  
Author(s):  
Piotr Piasecki ◽  
Marek Wierzbicki ◽  
Jerzy Narloch
Keyword(s):  
Rescue Therapy ◽  
Stent Retriever ◽  
Line Treatment ◽  
First Line ◽  
Safety And Efficacy ◽  
Single Center Experience ◽  
First Line Therapy ◽  
Rescue Treatment ◽  
Aspiration Technique ◽  
First Line Treatment

Introduction: We evaluated the safety and efficacy of a new stent retriever—Tigertriever—after failed aspiration.Materials and Methods: Patients with acute ischemic stroke treated with Tigertriever between January 2018 and March 2020 were included in the study. Treatment results of Tigertriever in rescue therapy (after failed aspiration) were evaluated. Periprocedural data were retrospectively analyzed.Results: Thirty patients were treated with Tigertriever (14M/16F). There were 20 rescue thrombectomies after failed aspiration. Tigertriver successful recanalization rate (mTICI ≥ 2B) was 70%: 65% in rescue therapy and 80% in first-line therapy. The type of first line treatment had no impact on mRS after 1 month and 3 months (ns). There was significant improvement in NIHSS in all patients (mean NIHSS: 17 vs. 10, p = 0.028), in rescue treatment (mean NIHSS: 17 vs. 11, p = 0.048) and in first line treatment (mean NIHSS: 16 vs. 8, p = 0.0005). Better results in NIHSS at discharge were linked with first pass success (p = 0.002), better mTICI at the end of the procedure (p = 0.0006), and administration of rtPA (p = 0.013).Conclusions: The new stent retriever Tigertriever is an efficient and safe tool to be used as a rescue device after an unsuccessful first line aspiration technique.

scholarly journals Modern Perspectives in the Treatment of Chronic Anal Fissures

2007 ◽  
Vol 89 (5) ◽  
pp. 472-478 ◽  
Author(s):  
R Bhardwaj ◽  
MC Parker
Keyword(s):  
Botulinum Toxin ◽  
Glyceryl Trinitrate ◽  
Rescue Therapy ◽  
Pharmacological Therapy ◽  
First Line ◽  
Pharmacological Agents ◽  
Anal Fissures ◽  
First Line Therapy ◽  
Rescue Treatment ◽  
The Uk

INTRODUCTION Anal fissures are commonly encountered in routine colorectal practice. Developments in the pharmacological understanding of the internal anal sphincter have resulted in more conservative approaches towards treatment. Simple measures are often effective for early fissures. Glyceryl trinitrate is well established as a first-line pharmacological therapy. The roles of diltiazem and botulinum, particularly as rescue therapy, are not well understood. Surgery has a defined role and should not be discounted completely. METHODS Data were obtained from Medline publications citing ‘anal fissure’. Manual cross-referencing of salient articles was conducted. We have sought to highlight various controversies in the management of anal fissures. FINDINGS Acute fissures may heal spontaneously, although simple conservative measures are sufficient. Idiopathic chronic anal fissures need careful evaluation to decide what therapy is suitable. Pharmacological agents such as glyceryl trinitrate (GTN), diltiazem and botulinum toxin have been subjected to most scrutiny. Though practices in the UK vary, GTN or diltiazem would be suitable as first-line therapy with botulinum toxin used as rescue treatment. Sphincterotomy is indicated for unhealed fissures; fissurectomy has been revisited and advancement flaps have a role in patients in whom sphincter division is not suitable.

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