A Comparison of 10 and 14 Days of Lansoprazole Triple Therapy for Eradication of Helicobacter pylori

Fennerty, M. Brian; Kovacs, Thomas O.; Krause, Richard A.; Haber, Marian M.; Weissfeld, Alice S.; Siepman, Nancy; Rose, Pamela

doi:10.1001/archinte.158.15.1651

Cited by 64 publications

(46 citation statements)

References 22 publications

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“…These combinations have consistently achieved eradication rates of >80% [22,23]. In the United States, regimens containing lansoprazole or omeprazole with clarithromycin and amoxicillin taken twice daily for 10-14 days have achieved FDA approval [30,32,33]. Recently, several other antimicrobials have been used to treat H. pylori with varying degrees of success.…”

Section: Opinion Statementmentioning

confidence: 99%

Helicobacter Pylori

Chey

1999

Curr Treat Options Gastro

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All infected patients with a peptic ulcer should be treated for H. pylori. The role of treating H. pylori in patients with undiagnosed dyspepsia or non-ulcer dyspepsia, those taking nonsteroidal anti-inflammatory medications, or with a family history of gastric cancer remains controversial. Triple therapies consisting of a proton pump inhibitor or ranitidine bismuth citrate and two antibiotics are the current standard of therapy for H. pylori. In general, dual therapies should no longer be used to treat H. pylori. Bismuth triple therapy consisting of bismuth, tetracycline, and metronidazole is a less expensive alternative to proton pump inhibitor-or ranitidine bismuth citrate-based triple therapies. However, bismuth triple therapy is hampered by frequent side effects and the need for qid dosing. In Europe, a 7-day course of therapy appears to be adequate. In the United States, 10-14 days of therapy are currently recommended. Metronidazole resistance in H. pylori strains varies geographically, and negatively influences the effectiveness of therapies containing this antibiotic. Clarithromycin resistance is relatively infrequent at the current time but may be rising in countries where this antibiotic is in use. If a patient remains infected after a course of therapy for H. pylori, the second treatment should avoid the antibiotics used initially.

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Section: Opinion Statementmentioning

confidence: 99%

Helicobacter Pylori

Chey

1999

Curr Treat Options Gastro

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“…Numerous therapeutic regimens have been evaluated for curing H. pylori infection [5]. However, no therapeutic regimen successfully treats all patients infected with H. pylori, and, therefore, failure of therapy is observed in 10-30% of treated individuals, even with the most effective regimens such as proton pump inhibitor (PPI)-based triple and quadruple therapies [5,6].…”

Section: Introductionmentioning

confidence: 99%

A Randomized Trial of Lansoprazole, Amoxycillin, and Clarithromycin versus Lansoprazole, Bismuth, Metronidazole and Tetracycline in the Retreatment of Patients Failing Initial <i>Helicobacter pylori</i> Therapy

Magaret

Burm

Faigel

et al. 2001

Dig Dis

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Background/Aim: 10–30% of the patients treated for Helicobacter pylori fail to clear the infection after initial therapy. Little is known as to the efficacy of retreatment regimens in these patients. Proton pump inhibitor (PPI) -based triple and quadruple therapies demonstrate efficacies of 80–90% as initial therapy for H. pylori infection, but whether these regimens are as effective when used for retreatment is unknown. The efficacy of a metronidazole-containing regimen in this situation is also unknown. Our aim was to compare the efficacy of a nonmetronidazole-containing PPI-based triple versus a PPI-based quadruple therapy containing metronidazole in patients failing previous H. pylori therapy. Methods: 48 patients were enrolled in this study at two sites after failure of previous H. pylori therapy as determined by a positive ¹⁴C-urea breath test. Patients were stratified by prior treatment with a metronidazole-containing regimen and were then randomized to either lansoprazole (L) 30 mg twice daily, amoxycillin (A) 1,000 mg twice daily, and clarithromycin (C) 500 mg twice daily for 14 days (LAC) or L 30 mg four times daily, bismuth subsalicylate (B) 2 tablets four times daily, metronidazole (M) 250 mg four times daily and tetracycline (T) 250 mg four times daily for 14 days (LBMT). Side effects and compliance (pill count) were assessed at the completion of therapy. A repeat ¹⁴C-urea breath test was performed 4 or more weeks after completion of therapy, and cure was defined as a negative test result. Results: 48 patients (16 males and 32 females) were enrolled in this study. 20 patients received LAC (18 prior M), and 28 received LBMT (23 prior M). Per protocol and intention-to-treat efficacies were 82% (95% CI 64–100%) and 75% (95% CI 56–94%) for LAC and 80% (96% CI 64–96%) and 71% (95% CI 54–88%) for LBMT (p = 0.85 per protocol and p = 0.78 intention to treat between LAC and LBMT), respectively. The compliance (≧80% of pills taken) was found to be 89% in both treatment groups. Side effects were noted in 84% for LAC and in 82% for LBMT, but were mild and did not cause discontinuation of therapy. Conclusions: PPI-based triple and quadruple therapy with both LAC and LBMT are effective in retreating patients failing initial metronidazole-based H. pylori therapies. LAC was not statistically superior to LBMT as a ‘retreatment’ regimen in this clinical situation, but the small sample size and wide confidence limits do not preclude the possibility of a smaller but significant difference in efficacy between the regimens. To determine whether LAC or LBMT is as effective for retreating patients failing non-metronidazole-containing regimens requires further study.

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“…The most commonly used regimen for H pylori therapy at present is twice-daily PPI-based triple therapy. This therapy employs a PPI, clarithromycin and amoxicillin (or metronidazole) (5), and achieves an eradication rate of approximately 85% in the United States (6)(7)(8).…”

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Is It Time for Quadruple Therapy to be First Line?

Laine

2003

Canadian Journal of Gastroenterology and Hepatology

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The most commonly used regimen for Helicobacter pylori therapy 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-resistant H pylori. Therefore, quadruple therapy can be considered a first line therapy for H pylori.Key Words: Bismuth; Duodenal ulcer; H pylori; Peptic ulcer Le temps de la quadrithérapie en première intention est-il arrivé?La forme la plus courante de traitement de l'infection à Helicobacter pylori consiste actuellement en la trithérapie fondée sur un inhibiteur de la pompe à protons (IPP) à prise biquotidienne. Vient ensuite la thérapie à base de bismuth. Lorsqu'un IPP est adjoint à la trithérapie comportant du bismuth, qui devient ainsi quadrithérapie, on observe une augmentation des taux de suppression par rapport à la trithérapie seule. Trois essais distincts, menés avec hasardisation sur trois continents, comparant la quadrithérapie à la trithérapie fondée sur un IPP ont produit des résultats remarquablement similaires. Les taux de suppression enregistrés pour la trithérapie et la quadrithérapie différaient peu. Les derniers se sont révélés de 3 à 6 % supérieurs aux premiers, ce qui indique que la quadrithérapie ne devrait pas se montrer moins efficace que la trithérapie fondée sur un IPP. De plus, les chercheurs ont noté des taux similaires d'observance thérapeutique et d'effets indésirables pour les deux formes de traitement. Le grand avantage possible de la quadrithérapie a trait à la résistance aux antibiotiques. Chez les patients résistants à la clarithromycine, la trithérapie à base d'un IPP, contrairement à la quadrithérapie, a produit des taux de suppression sensiblement plus faibles. Par ailleurs, compte tenu de sa capacité de vaincre en grande partie la résistance au métroni-dazole, la quadrithérapie a peu ou pas été associée à une diminution des taux de suppression comparativement à la trithé...

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A Comparison of 10 and 14 Days of Lansoprazole Triple Therapy for Eradication of Helicobacter pylori

Abstract: Background: Data from large, multicenter, US studies determining the efficacy of triple therapy for the eradication of Helicobacter pylori are lacking, especially for a treatment duration of less than 14 days.

Cited by 64 publications

References 22 publications

Helicobacter Pylori

Helicobacter Pylori

A Randomized Trial of Lansoprazole, Amoxycillin, and Clarithromycin versus Lansoprazole, Bismuth, Metronidazole and Tetracycline in the Retreatment of Patients Failing Initial <i>Helicobacter pylori</i> Therapy

Is It Time for Quadruple Therapy to be First Line?

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