Ten-day empirical sequential or concomitant therapy is more effective than triple therapy for Helicobacter pylori eradication: A multicenter, prospective study

Chung, Jun‐Won; Han, Jae Pil; Kim, Kyoung Oh; Kim, Su Young; Hong, Su Jin; Kim, Tae Ho; Kim, Chang Whan; Kim, Joon Sung; Kim, Byung‐Wook; Bang, Byoung Wook; Kim, Hyung Gil; Yun, Sung‐Cheol

doi:10.1016/j.dld.2016.05.005

Cited by 35 publications

(29 citation statements)

References 29 publications

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“…16,17 Concomitant therapy (CT) containing PPI, AMO, CLA, and MET was shown to be more effective than triple therapy and was one of the most effective treatments with a high eradication rate. 18 Consensus reports recommend that both bismuth quadruple therapy and concomitant therapy can be used as a first-line treatment in regions with high antibiotic resistance or susceptibility testing is not available. 19,20 For children, it is important to improve the success rate of firstline treatment due to the limited number of antibiotics that are appropriate to use for rescue therapy.…”

Section: Backg Rou N Dmentioning

confidence: 99%

Comparison of four different regimens against Helicobacter pylori as a first‐line treatment: A prospective, cross‐sectional, comparative, open trial in Chinese children

et al. 2020

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Backgrounds Due to the decreasing eradication rate of Helicobacter pylori, some novel alternatives have been developed, such as bismuth‐containing quadruple therapy and non‐bismuth‐containing quadruple therapy (sequential and concomitant treatment). Little is known about whether a success rate above 90% can be achieved with these regimens in Chinese children. Methods In this prospective, open, comparative cross‐sectional study, we recruited treatment‐naïve children (aged between 6 and 18 years) with H pylori infection. The patients were assigned either standard triple therapy, sequential therapy, bismuth‐based quadruple therapy, or concomitant therapy at the discretion of the prescribing physician. H pylori infection was evaluated at least 4 weeks after the completion of the treatment. A negative urea breath test (UBT) indicated successful eradication. The primary endpoint was the eradication frequency of H pylori in the full analysis set (FAS), which included all children who received at least one dose of the treatment and with available follow‐up data. Results Between September 2017 and December 2018, 228 patients were finally included in the FAS analyses. The eradication rates were 74.1% for standard triple therapy (43/58, [95% CI: 62.8%‐85.5%]), 69.5% for sequential therapy (41/59, [95% CI: 57.8%‐81.2%]), 89.8% for bismuth‐based quadruple therapy (53/59, [95% CI: 82.1%‐97.5%]), and 84.6% for concomitant therapy (44/52, [95% CI: 74.8%‐94.4%]). Bismuth‐based therapy was superior to triple therapy, while sequential therapy and concomitant therapy were not superior to triple therapy. The frequency of adverse events was 12.1% (7/58) in standard triple therapy, 6.8% (4/59) in sequential therapy, 15.3% (9/59) in bismuth‐based therapy, and 15.4% (8/52) in concomitant therapy. The rate of adverse events was similar among the four groups. Conclusion Bismuth quadruple therapy can achieve an eradication rate of 89.8% as first‐line treatment and is safe and well tolerated. Bismuth could be a promising alternative as a first‐line regimen in Chinese children.

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Section: Backg Rou N Dmentioning

confidence: 99%

Comparison of four different regimens against Helicobacter pylori as a first‐line treatment: A prospective, cross‐sectional, comparative, open trial in Chinese children

et al. 2020

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“…In a Korean study, where 10‐ and 14‐day sequential and concomitant regimes were all used, all four regimens revealed eradication rates greater than 90% with the highest rate (98.5%) being for 14‐day concomitant therapy . A second Korean study compared triple therapy with sequential and concomitant regimens and found eradication rates of 62.6%, 70.6%, and 77.8% . In a Greek prospective study, concomitant therapy outperformed sequential therapy by 89.1% vs 78.7% .…”

Section: Sequential Concomitant and Hybrid Therapymentioning

confidence: 99%

Treatment of Helicobacter pylori infection 2017

et al. 2017

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Over the last decade, it has been widely reported that the success of Helicobacter pylori eradication treatment is falling. A steady decline was observed in the number of patients achieving eradication with standard first-line triple therapy of two antibiotics and a proton pump inhibitor [1][2][3]. It now appears that the first-line eradication therapies most commonly used in everyday clinical practice fall considerably short of the 80% intention-to-treat (ITT) eradication rates that are considered the minimal acceptable levels as recommended in the Maastricht guidelines [4]. Interestingly, two studies emerged from Asian centers in the last 12 months, which show that, in this part of the world at least, eradication levels using standard therapies remain close to 80%. A Malaysian study showed a standard 1-week pantoprazole, amoxycillin, and clarithromycin regimen to be well tolerated and highly efficacious with a per-protocol eradication rate of 84% [5]. A Japanese study showed remarkably consistent per-protocol eradication rates from 2001 to 2009 fluctuating between 75 and 78% for standard 7-day triple-therapy regimens [6]. A limit of many studies especially those including clarithromycin or levofloxacin is that H. pylori susceptibility to the drugs, which is the main prediction of failure, was not tested. LevofloxacinThe use of levofloxacin as a first-line therapy has been examined in great depth in the last year. Levofloxacin may be used as a substitute for clarithromycin in either a standard triple or sequential regimen. A large study comparing the antibiotics in either regimen shows a clear advantage to levofloxacin in both combinations. Per-protocol cure rates for triple therapy were 66% for omeprazole-clarithromycin-amoxycillin compared with 83% for omeprazole-levofloxacin-amoxycillin and 81% for omeprazole-amoxycillin-clarithromycin-metronidazole vs 85% for omeprazole-amoxycillin-levofloxacinmetronidazole, with no difference in compliance rates or adverse events [7]. It has been proposed that sequential levofloxacin-based regimens are of most benefit in areas where clarithromycin resistance is in excess of 15%, and another study in such an area showed eradication rates of 81% with clarithromycin sequential therapy compared with 96% with levofloxacin sequential therapy. A third arm in this study looked at the dose of levofloxacin required and illustrated no benefit in increasing the dose from 250 to 500 mg [8]. Indeed, another study went so far as to suggest that once-daily dosing of a levofloxacin-based triple regimen may be as efficacious as twice daily [9]. The literature from Asia also seems to support levofloxacin as a good alternative first-line therapy. A study on a triple regimen showed per-protocol eradication rates of 78% for standard clarithromycin-containing therapies compared with 83% for a levofloxacin-based regimen [10]. Another study from the Middle East looked at whether combining clarithromycin and levofloxacin in the same regimen could be Keywords Peptic ulcer disease, resistance, compli...

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“…In 2013, there was no difference of eradiation rate between 14 days-sequential therapy and 14 days-concomitant therapy (ITT analysis: 75.6% vs. 80.8%, P=0.423) [42]. Two studies published in 2016 also did not show any difference of eradication rate between sequential and concomitant therapy (ITT analysis: 10 days-sequential vs. 10 days-concomitant therapy, 70.6% vs. 77.8%, P=0.140; 10 days-sequential vs. 14 days-sequential vs. 10 days-concomitant vs. 14 days concomitant therapy, 77.6% vs. 73.8% vs. 75.6% vs. 77.9%, P=0.915) [43,44].…”

Section: Concomitant Therapymentioning

confidence: 99%

The first-line regimens of Helicobacter pylori eradication in Korea

Park

2017

Hanyang Med Rev

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This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.Approximately half of the world's population is infected by Helicobacter pylori, which causes various gastrointestinal diseases including gastritis, peptic ulcer, gastric mucosa-associated lymphoid tissue lymphoma, and gastric cancer. The conventional triple therapy, that consists of proton pump inhibitor (PPI), amoxicillin, and clarithromycin, is widely used in Korea because of high resistance rates of H. pylori against metronidazole. Recently, however, clarithromycin-resistance rates have also increased and the eradication rate of conventional triple therapy has been unacceptable. In order to increase the eradication rate of H. pylori, various regimens have been suggested. Understanding H. pylori eradication regimens will help select drugs in the management of H. pylori infection.

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Ten-day empirical sequential or concomitant therapy is more effective than triple therapy for Helicobacter pylori eradication: A multicenter, prospective study

Cited by 35 publications

References 29 publications

Comparison of four different regimens against Helicobacter pylori as a first‐line treatment: A prospective, cross‐sectional, comparative, open trial in Chinese children

Comparison of four different regimens against Helicobacter pylori as a first‐line treatment: A prospective, cross‐sectional, comparative, open trial in Chinese children

Treatment of Helicobacter pylori infection 2017

The first-line regimens of Helicobacter pylori eradication in Korea

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