Amoxicillin‐Tetracycline Combinations are Inadequate as Alternative Therapies for <i>Helicobacter pylori</i> Infection

Perri, Francesco; Festa, V.; Merla, Antonio; Quitadamo, M.; Clemente, R.; Andriulli, Angelo

doi:10.1046/j.1083-4389.2002.00066.x

Cited by 31 publications

(36 citation statements)

References 23 publications

(30 reference statements)

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“…Eleven of the studies were multicentre RCTs [15,21,25,29,31,32,34,39,41,44,45] . Duration of bismuth therapy ranged from 7 to 56 d, with a total daily dose of between 400 mg and 2100 mg. Nineteen studies used ranitidine bismuth citrate [15,17,20,22,24,[28][29][30][31][32]34,36,[39][40][41]43,45,46,48] , ten studies colloidal bismuth subcitrate [7,16,18,21,26,27,37,38,42,44] , two studies tripotassium dictrato bismuthate [23,35] , two studies bismuth subsalicylate [25,33] , one study bismuth subnitrate [19] , and one study both bismuth subnitrate and www.wjgnet.com…”

Section: Trial Characteristicsmentioning

confidence: 99%

“…Ten of the studies reported the method of generation of the randomization schedule [15,18,20,26,30,32,37,39,47,48] , but only four the method of concealment of allocation [27,32,47,48] . Four of the studies recorded adverse events using a questionnaire [20,24,28,40] , but only two of these stated that the questionnaire was validated [24,28] . Seven studies collected information concerning adverse events using a diary or diary cards [21,27,32,[34][35][36]48] , two via face-toface interview [43,45] , and one via telephone interview [46] .…”

Section: Trial Qualitymentioning

confidence: 99%

“…Headache: Fourteen trials reported the total number of individuals experiencing headache with bismuth or bismuth-containing regimens versus comparison regimen [17,18,20,[24][25][26]30,31,34,[39][40][41]46,47] . Five of these studies utilized more than one regimen [20,31,34,41,47] , allowing 19 comparisons to be made.…”

Section: Dizzinessmentioning

confidence: 99%

“…Nineteen of the trials were conducted in Europe [15][16][17][18]20,[23][24][25][27][28][29][30]37,40,[42][43][44][45]47] , eight in the Far East [21,22,32,35,36,38,46,48] , four in the USA [31,33,34,41] , one in the Middle East [26] , one in South America [19] , one in Australia [7] , and one was a multi-national study [39] . Eleven of the studies were multicentre RCTs [15,21,25,29,31,32,34,39,41,44,45] .…”

Section: Trial Characteristicsmentioning

confidence: 99%

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Adverse events with bismuth salts for Helicobacter pylori eradication: Systematic review and meta-analysis

Ford

Malfertheiner²,

Giguere³

et al. 2008

WJG

106

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INTRODUCTIONBismuth salts have been used for centuries in medicine. From a gastroenterology perspective these drugs have been used to treat peptic ulcer disease, dyspepsia, parasitic infections, microscopic colitis, and infectious diarrhoea [1] . The discovery of Helicobacter pylori (H pylori) in 1983 by Warren and Marshall revolutionised the management of peptic ulcer disease [2] , and led to a renewed interest in bismuth compounds, largely because bismuth was found to inhibit the growth of H pylori and was effective in eradicating the organism (when combined with antibiotics or in combination with antibiotics and acid suppression therapy [3,4] ). The first randomised controlled trial (RCT) of bismuth in H pylori-positive individuals suggested that bismuth was superior to erythromycin monotherapy in eradicating the infection [5] . A further RCT of 6 wk of colloidal bismuth subcitrate versus cimetidine, in H pylori-positive duodenal ulcer patients, demonstrated that bismuth successfully eradicated the bacterium in up to 50% of patients [6] . Subsequently, an RCT of both colloidal bismuth subcitrate and cimetidine, alone or in combination with tinidazole, confirmed that colloidal bismuth subcitrate and tinidazole cleared the infection in almost 75% of patients [7] . With the addition of a second antibiotic, tetracycline or amoxicillin, eradication rates in later RCTs exceeded 80% [8][9][10] . However, there were some problems associated with bismuth-based triple therapy, which included the number of tablets patients were required to take, the duration of therapy, and side effects such as altered taste, nausea, and diarrhoea. Abstract AIM: To assess the safety of bismuth used in Helicobacter pylori (H pylori ) eradication therapy regimens. METHODS:We conducted a systematic review and meta-analysis. MEDLINE and EMBASE were searched (up to October 2007) to identify randomised controlled trials comparing bismuth with placebo or no treatment, or bismuth salts in combination with antibiotics as part of eradication therapy with the same dose and duration of antibiotics alone or, in combination, with acid suppression. Total numbers of adverse events were recorded. Data were pooled and expressed as relative risks with 95% confidence intervals (CI). RESULTS: We identified 35 randomised controlled trials containing 4763 patients. There were no serious adverse events occurring with bismuth therapy. There was no statistically significant difference detected in total adverse events with bismuth [relative risk (RR) = 1.01; 95% CI: 0.87-1.16], specific individual adverse events, with the exception of dark stools (RR = 5.06; 95% CI: 1.59-16.12), or adverse events leading to withdrawal of therapy (RR = 0.86; 95% CI: 0.54-1.37).CONCLUSION: Bismuth for the treatment of H pylori is safe and well-tolerated. The only adverse event occurring significantly more commonly was dark stools.

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Section: Trial Characteristicsmentioning

confidence: 99%

Section: Trial Qualitymentioning

confidence: 99%

Section: Dizzinessmentioning

confidence: 99%

Section: Trial Characteristicsmentioning

confidence: 99%

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Adverse events with bismuth salts for Helicobacter pylori eradication: Systematic review and meta-analysis

Ford

Malfertheiner²,

Giguere³

et al. 2008

WJG

106

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“…14 In a study comparing arms with tetracycline and doxycycline, both arms had similar eradication rates. 15 The main difference in antimicrobial resistance between the two drugs is that doxycycline can inhibit some tetracycline resistant Gram-positive bacteria. 16 Results suggest similar eradication rates, but there was significantly better compliance with doxycycline.…”

Section: Discussionmentioning

confidence: 99%

Furazolidona, tetraciclina e omeprazol: uma alternativa de baixo custo para erradicação de Helicobacter pylori em crianças

Machado¹,

Silva²,

Viriato³

2008

J. Pediatr. (Rio J.)

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Objectives: To evaluate furazolidone, tetracycline and omeprazole as first line therapy for Helicobacter pylori in children with digestive symptoms. Methods:Prospective and consecutive open trial. The study included patients older than 8 years old with functional dyspepsia, functional abdominal pain, severe histological abnormalities (intestinal metaplasia, gastric atrophy or mucosa-associated lymphoid tissue lymphoma) or peptic ulcer. H. pylori status was defined based both upon histology and rapid urease test. Drug regimen was a 7-day course of omeprazol, tetracycline (or doxycycline) and furazolidone twice daily. Eradication was assessed by upper endoscopy 2 months after treatment (histology and rapid urease test).Further clinical evaluation was done 7 days and 2 months after treatment.Results: Thirty-six patients (21 female/15 male) were included. Age ranged from 8 to 19 years (mean 12.94±2.89 years). On intention-to-treat analysis (n = 36), eradication rate was 83.3% (95%CI 77.1-89.5) whereas in per-protocol analysis (n = 29), it was 89.7% (95%CI 84.6-94.7). Compliance was better when doxycycline was used, but the success rates were similar for the two tetracyclines. There was no variable associated with treatment failure. Side effects were reported in 17 patients (47.2%), mainly abdominal pain (11/30.5%), nausea (seven/19.4%) and vomiting (five/ 13.9%). Conclusion:Triple therapy with furazolidone and tetracycline is a low-cost alternative regimen to treat H. pylori infection.J Pediatr (Rio J). 2008;84(2):160-165: Furazolidone, tetracycline, Helicobacter pylori treatment, child, clinical trial.

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Advantages of deuterium‐labelled mixed triacylglycerol in studies of intraluminal fat digestion

Slater

Preston

Weaver

2005

Rapid Comm Mass Spectrometry

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The 13 C-mixed triacylglcerol (MTG,1, C]octanoyl glycerol) breath test is a noninvasive measure of intraluminal fat digestion. Recovery of 13 C in breath CO 2 is incomplete (<50%) owing to sequestration of 13 C into organic molecules via the tricarboxylic acid (TCA) cycle. In addition lack of knowledge of CO 2 production rate (VCO 2 ) during the test leads to errors in the calculated percentage dose recovered (PDR). 2H sequestration into organic molecules is low ($4%) and is not influenced by factors that affect VCO 2 such as food intake or physical activity. After oxidation of 2 H-labelled macromolecules, the label appears in body water, which can be sampled O was calculated from the plateau enrichment, which was reached by 6 h in both saliva and urine. Recovery of 2 H calculated using measured TBW was compared with that using an estimated value of TBW. Mean recovery of 2 H in saliva was 99.3% and in urine was 96.4%. Errors introduced by estimating TBW were <5%. 1 -10 13 C-breath tests are particularly attractive for use in children because they are non-invasive, and pose no radiation hazard. A problem with many 13 C-breath tests is that recovery of 13 C in breath CO 2 is less than 50%, even in healthy subjects, owing to the sequestration of label into organic compounds via acetylCoA and the tricarboxylic acid (TCA) cycle. 3,11 -16 Quantitation of tracer recovery requires knowledge of carbon dioxide production rate (VCO 2 ) because labelled CO 2 originating from oxidation of the tracer is diluted by endogenously produced CO 2 from metabolism. A resting value of VCO 2 based on basal metabolic rate is often assumed, 11,14 but, even if resting VCO 2 is measured, 17,18 this may not be appropriate because subjects, especially children, rarely remain at rest for the duration of the test, which typically lasts for about 6 h. VCO 2 is increased during physical activity and after food intake; therefore, use of resting VCO 2 will underestimate the true CO 2 production rate resulting in an underestimation of the quantity of tracer recovered. 16,19 Another confounding factor for 13 C-breath tests is the natural abundance variation in the usual diet, 20,21 resulting in the need for subjects to eat a diet containing ingredients of low 13 C abundance, possibly for several days before the test and during the test. The mixed triacylglycerol (MTG) breath test was developed as an indirect measure of intraluminal fat digestion in adults with impaired pancreatic function.9,22 The 13 C [MTG] breath test has been used to assess the need for pancreatic enzyme replacement therapy in children with cystic fibrosis and to assess the ideal dose, 3,8 but it has not been widely adopted because it lacks specificity, 23 and requires frequent breath sampling over a period of 5-6 h. [1-13 C]octanoate, which is absorbed and reaches the liver via the portal vein. Less than 5% ingested 13 C is excreted in

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Amoxicillin‐Tetracycline Combinations are Inadequate as Alternative Therapies for Helicobacter pylori Infection

Abstract: Although the amoxicillin/tetracycline combination is attractive (inexpensive, safe, and with low primary resistance rate), it can not be recommended for H. pylori eradication.

Cited by 31 publications

References 23 publications

Adverse events with bismuth salts for Helicobacter pylori eradication: Systematic review and meta-analysis

Adverse events with bismuth salts for Helicobacter pylori eradication: Systematic review and meta-analysis

Furazolidona, tetraciclina e omeprazol: uma alternativa de baixo custo para erradicação de Helicobacter pylori em crianças

Advantages of deuterium‐labelled mixed triacylglycerol in studies of intraluminal fat digestion

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