Clarithromycin–Amoxycillin‐Containing Triple Therapy: A Valid Empirical First‐Line Treatment for <i>Helicobacter pylori</i> Eradication in Hong Kong?

Hung, Ivan Fan-Ngai; Chan, Pierre; Leung, Sally S. M.; Chan, F.H.Y.; Hsu, Axel; But, David; Seto, Wai Kay; Wong, Siew Sun; Chan, Chi Kuen; Gu, Qing; Tong, Teresa; Cheung, Ting Kin; Chu, Kent Man; Wong, Benjamin C.Y.

doi:10.1111/j.1523-5378.2009.00722.x

Cited by 39 publications

(35 citation statements)

References 29 publications

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“…These results are similar to those observed in the works of Bellelis [20], and Coelho [22] in research studies also conducted in Brazil. Results in works from Taiwan [23], Kuwait [24], Hong Kong [25], Iran [26], and Chile [27] have presented similar results regarding the efficacy of triple therapy. Metaanalysis of published works regarding the differences between the PPI in H. pylori treatment regimens showed eradication rates between 82% and 84% when they were combined with amoxicillin and clarithromycin [15,16].…”

Section: Discussionsupporting

confidence: 66%

“…Second-and third-generation macrolides have been commercially available for a long time, but they are not used widely due to their elevated cost, a fact which may suffice to explain these low resistance rates in our country. Conversely, the widespread use of nitroimidazolic compounds to treat parasitic infections, sexually transmitted diseases, and gynecological infections might be responsible for the significant reduction in H. pylori metronidazole sensitivity as several authors have observed [11,12,25,[36][37][38][39]41].…”

Section: Discussionmentioning

confidence: 99%

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Clarithromycin-based triple therapy for Helicobacter pylori treatment in peptic ulcer patients

Felga

Silva

Navarro–Rodriguez

et al. 2010

J Infect Dev Ctries

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Introduction: The scheme proton pump inhibitor/amoxicillin/clarithromycin (PPI/AC) is still the first-line treatment for Helicobacter pylori (H. pylori) infections despite evidence suggesting its failure in up to 20% to 30% of patients. Methodology: This study involved 493 patients who were prescribed omeprazole (20 mg twice a day) or another proton pump inhibitor in equivalent dosage, amoxicillin (1 g twice a day), and clarithromycin (500 mg twice a day) for seven days. Efficacy was determined by negative urease test and absence of H. pylori on gastric biopsy samples twelve weeks after the end of treatment. Safety was defined according to the adverse effects reported. Mean age of the patients was (± SD) 48.96 ± 13, and demographic and clinical data were recorded for correlation with treatment outcomes. Results: Out of 493 patients, 316 (64.1%) presented duodenal ulcer, 111 (22.5%) gastric ulcer, and 66 (14.4%) simultaneous gastric and duodenal ulcers. Additionally, 267 (54.2%) patients had at least one risk factor for peptic ulcer disease, smoking being the most common (99 [36.5%]). Successful eradication was achieved in 408 patients. The eradication rates per protocol, and according to the intention to treat, were 88.8% and 82.7%, respectively. Of 164 (35.5%) patients who presented adverse effects, 100 (61%) reported them as mild and only six (3.7%) patients had to discontinue treatment. Previous use of tobacco and non-steroid anti-inflammatory drugs was the only risk factor for treatment failure (P 0.00). Conclusion: PPI/AC is still a valuable and remarkably tolerable option for first-line H. pylori eradication in Brazil.

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Section: Discussionsupporting

confidence: 66%

Section: Discussionmentioning

confidence: 99%

Clarithromycin-based triple therapy for Helicobacter pylori treatment in peptic ulcer patients

Felga

Silva

Navarro–Rodriguez

et al. 2010

J Infect Dev Ctries

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“…Figure 1 shows the flow diagram of the process by which articles were selected. Finally, 13 RCTs met our predefined inclusion and exclusion criteria and were qualified for the meta-analysis [8]–[9], [11]–[21]. From 13 RCTs, two of them [16], [20] were excluded because of their Jadad score was <3, three of them [8], [11], [14], compared 10 days of levofloxacin based regimen to 10 days of standard therapy, and the study by Zullo et al [21] was excluded because the standard arm was unique and contained 7 days of Clarithromycin, Tinidazole, Bovine Lactoferrin and Rabeprazole.…”

Section: Resultsmentioning

confidence: 99%

“…However, the eradication rates achieved with first-line levofloxacin-based treatments are not uniform. Some reports show improved efficacy with levofloxacin-based regimens in comparison to standard first-line therapy, whereas others have found equivalent or poorer responses [9], [11]–[12].…”

Section: Introductionmentioning

confidence: 99%

Levofloxacin-Based First-Line Therapy versus Standard First-Line Therapy for Helicobacter pylori Eradication: Meta-Analysis of Randomized Controlled Trials

2014

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BackgroundFirst-line levofloxacin-based treatments eradicate Helicobacter pylori with varying success. We examined the efficacy and safety of first-line levofloxacin-based treatment in comparison to standard first-line therapy for H pylori eradication.Materials and MethodsWe searched literature databases from Medline, EMBASE, and the Cochrane Register of Randomized Controlled Trials through March 2013 for randomized controlled trials comparing first-line levofloxacin and standard therapy. We included randomized controlled trials conducted only on naïve H pylori infected patients in adults. A systematic review was conducted. Meta-analysis was performed with Review Manager 5.2. Treatment effect was determined by relative risk with a random or fixed model by the Mantel-Haenszel method.ResultsSeven trials were identified with 888 patients receiving 7 days of first-line levofloxacin and 894 treated with standard therapy (Amoxicillin, Clarithromycin and proton pump inhibitor) for 7 days. The overall crude eradication rate in the Levofloxacin group was 79.05% versus 81.4% in the standard group (risk ratio 0.97; 95% CI; 0.93, 1.02). The overall dropout was 46 (5.2%) in the levofloxacin group and 52 (5.8%) for standard therapy. The dizziness was more common among group who took Levofloxacin based treatment and taste disturbance was more common among group who took standard therapy. Meta-analysis of overall adverse events were similar between the two groups with a relative risk of 1.06 (95% CI 0.72, 1.57).Conclusion Helicobacter pylori eradication with 7 days of Levofloxacin-based first line therapy was safe and equal compared to 7 days of standard first-line therapy.

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“…The start date of the prescriptions should be the same, with an overlapping duration of 7–14 days. Clarithromycin-based triple therapy was the first-line therapy for H. pylori in Hong Kong during the study period due to the low clarithromycin resistance rate (8%)23 and overall high eradication rate (>90%) 24. To remove the confounding effects of symptoms from gastric cancer leading to the use of PPIs or histamine 2-receptor antagonist (H2RA) (ie, protopathic bias), prescriptions of these agents started within 6 months prior to the gastric cancer diagnosis were excluded 25 26…”

Section: Methodsmentioning

confidence: 99%

Long-term proton pump inhibitors and risk of gastric cancer development after treatment for Helicobacter pylori: a population-based study

Cheung

Chan

Wong

et al. 2017

Gut

380

370

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Objective Proton pump inhibitors (PPIs) is associated with worsening of gastric atrophy, particularly in Helicobacter pylori (HP)-infected subjects. We determined the association between PPIs use and gastric cancer (GC) among HP-infected subjects who had received HP therapy. Designs This study was based on a territory-wide health database of Hong Kong. We identified adults who had received an outpatient prescription of clarithromycinbased triple therapy between year 2003 and 2012. Patients who failed this regimen, and those diagnosed to have GC within 12 months after HP therapy, or gastric ulcer after therapy were excluded. Prescriptions of PPIs or histamine-2 receptor antagonists (H2RA) started within 6 months before GC were excluded to avoid protopathic bias. We evaluated GC risk with PPIs by Cox proportional hazards model with propensity score adjustment. H2RA was used as a negative control exposure. result Among the 63 397 eligible subjects, 153 (0.24%) developed GC during a median follow-up of 7.6 years. PPIs use was associated with an increased GC risk (HR 2.44, 95% CI 1.42 to 4.20), while H2RA was not (HR 0.72, 95% CI 0.48 to 1.07). The risk increased with duration of PPIs use (HR 5.04, 95% CI 1.23 to 20.61; 6.65, 95% CI 1.62 to 27.26 and 8.34, 95% CI 2.02 to 34.41 for ≥1 year, ≥2 years and ≥3 years, respectively). The adjusted absolute risk difference for PPIs versus nonPPIs use was 4.29 excess GC (95% CI 1.25 to 9.54) per 10 000 person-years. conclusion Long-term use of PPIs was still associated with an increased GC risk in subjects even after HP eradication therapy.

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Clarithromycin–Amoxycillin‐Containing Triple Therapy: A Valid Empirical First‐Line Treatment for Helicobacter pylori Eradication in Hong Kong?

Cited by 39 publications

References 29 publications

Clarithromycin-based triple therapy for Helicobacter pylori treatment in peptic ulcer patients

Clarithromycin-based triple therapy for Helicobacter pylori treatment in peptic ulcer patients

Levofloxacin-Based First-Line Therapy versus Standard First-Line Therapy for Helicobacter pylori Eradication: Meta-Analysis of Randomized Controlled Trials

Long-term proton pump inhibitors and risk of gastric cancer development after treatment for Helicobacter pylori: a population-based study

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