Bioavailability of antimicrobials after oral and parenteral administration

Goddard, Andrew; Sherwood, Paul

doi:10.1007/978-94-011-4882-5_41

Cited by 3 publications

(3 citation statements)

References 27 publications

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“…Resistance of H pylori to commonly used antibiotics is a recognized problem (26,27). Marked geographical variation for primary drug resistance to H pylori in children was observed (Figures 2 and 3).…”

Section: Drug Resistancementioning

confidence: 95%

An Update on Anti-Helicobacter Pylori Treatment in Children

Khurana

Fischbach

Chiba

et al. 2005

Canadian Journal of Gastroenterology

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Previous consensus statements have recommended one- to two-week proton pump inhibitor (PPI)-based triple therapies with clarithromycin and either amoxicillin or metronidazole as first-line treatments for children with Helicobacter pylori infection. The objective of the present review was to summarize data from pediatric studies that have examined treatment efficacy, safety, drug resistance and reinfection rates related to anti-H. pylori therapies. Data from a recent meta-analysis of pediatric studies were used along with the authors' existing databases and searches of individual studies. Regimens that were identified as greater than 80% efficacious in children included a two-week therapy with a nitroimidazole and amoxicillin in Europe; a two-week regimen of bismuth, amoxicillin and metronidazole in developed countries (except Spain); a one- to two-week regimen of a PPI, clarithromycin and amoxicillin in Northern Europe, Asia and the Middle East; and a two-week regimen of a PPI, clarithromycin and metronidazole in Canada. Although recommended as a first-line treatment in adults, two-week treatment with a PPI, clarithromycin and amoxicillin eradicated only 68% of H. pylori infections in North American children. Treatment efficacy was reduced in the presence of metronidazole and/or clarithromycin resistance. Further studies of anti-H. pylori treatments in children in North America and developing countries are warranted.

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Section: Drug Resistancementioning

confidence: 95%

An Update on Anti-Helicobacter Pylori Treatment in Children

Khurana

Fischbach

Chiba

et al. 2005

Canadian Journal of Gastroenterology

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“…In addition, minimal inhibitory concentrations of amoxicillin and clarithromycin decrease as pH increases 5 , . 6 Finally, proton pump inhibitors may have an intrinsic antibacterial effect. It has been demonstrated that proton pump inhibitors inhibit H. pylori survival at neutral pH in vitro , 7 attenuate its ability to survive in vitro at acidic pH, 8 and selectively inhibit its urease activity 9 …”

Section: Introductionmentioning

confidence: 99%

Single vs. double dose of a proton pump inhibitor in triple therapy for Helicobacter pylori eradication: a meta‐analysis

Vallve

Vergara

Gisbert

et al. 2002

Aliment Pharmacol Ther

121

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Background: Triple therapies combining a double dose of proton pump inhibitor plus two antibiotics are the standard treatment for Helicobacter pylori infection. Some reports suggest that the use of half the dose of proton pump inhibitor is equally effective. Aim: To compare the efficacy of a single vs. double dose of proton pump inhibitor in triple therapy. Methods: We conducted a MEDLINE search. The search strategy included the words (pylori) AND (triple, PPI, proton pump, omeprazole, rabeprazole, pantoprazole, lansoprazole, clarithromycin, amoxicillin, amoxycillin or metronidazole). Abstracts of the articles obtained and papers presented at the European Helicobacter pylori Study Group and American Gastroenterological Association congresses from 1996 to 2001 were examined. Inclusion criteria were: (i) randomized studies with at least two branches of triple therapy including a proton pump inhibitor and two standard antibiotics; (ii) branches could differ only in terms of proton pump inhibitor dosage. A meta‐analysis was conducted using conventional shareware (Review Manager 4.1). Results: Thirteen studies met the inclusion criteria with a total of 2391 patients. Cure rates with double doses of proton pump inhibitor were higher in both the intention‐to‐treat analysis (83.9% vs. 77.7%; Peto odds ratio, 1.51; 95% confidence interval, 1.23–1.85; P < 0.01) and per protocol analysis (89% vs. 81%; Peto odds ratio, 1.96; 95% confidence interval, 1.55–2.47; P < 0.01). Conclusion: Triple therapies containing a single dose of proton pump inhibitor are less effective than those containing a standard double dose of proton pump inhibitor.

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“…17 Omeprazole also improves the stability of amoxicillin and the susceptibility of H pylori to this antibiotic. 21 Studies of gastric transport of amoxicillin in humans are problematic due to contamination of gastric aspirate samples with amoxicillin-rich bile and the difficulty in detecting low concentrations of amoxicillin. We were able to demonstrate a very low gastric amoxicillin transfer rate in the rat consistent with that seen in humans.…”

Section: Discussionmentioning

confidence: 99%

Impact of acid secretion, gastritis, and mucus thickness on gastric transfer of antibiotics in rats

Sherwood

2002

Gut

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Background and aims: The success of Helicobacter pylori eradication regimens depends on gastric pH, inflammation, and mucus thickness. Our aim was to investigate the effects of acid secretion, inflammation, and mucolysis on gastric antibiotic transfer. Subjects and methods: A total of 134 anaesthetised rats were given metronidazole, amoxicillin, or clarithromycin intravenously and gastric contents were aspirated via an indwelling cannula. Acid secretion was controlled by either omeprazole or pentagastrin while gastritis was induced by infection with H pylori or dosing with iodoacetamide. Mucolysis was achieved by instilling pronase into the gastric lumen. Results: Metronidazole transfer increased with acid secretion and fell with omeprazole, independently of gastric pH. Clarithromycin was also transferred with acid but was then rapidly degraded. Omeprazole prevented this degradation, raising gastric luminal concentrations. Omeprazole did not alter amoxicillin transfer. Gastritis induced by H pylori did not alter gastric transfer of metronidazole and amoxicillin but that of clarithromycin was increased by 23%. However, gastritis induced by iodoacetamide reduced clarithromycin transfer without any effect on metronidazole or amoxicillin transfer. Pronase treatment increased amoxicillin transfer fourfold and metronidazole by 66% but reduced clarithromycin transfer by 35%. Conclusions: Metronidazole and clarithromycin are predominantly transferred with gastric acid rather than by an acid trapping mechanism. Pronase increases the appearance of amoxicillin and metronidazole in gastric secretions.

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Bioavailability of antimicrobials after oral and parenteral administration

Cited by 3 publications

References 27 publications

An Update on Anti-Helicobacter Pylori Treatment in Children

An Update on Anti-Helicobacter Pylori Treatment in Children

Single vs. double dose of a proton pump inhibitor in triple therapy for Helicobacter pylori eradication: a meta‐analysis

Impact of acid secretion, gastritis, and mucus thickness on gastric transfer of antibiotics in rats

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