Comparative efficacy of different proton pump inhibitors in triple therapy for Helicobacter pylori eradication: A meta-analysis

Vergara, Mercedes; Vallve, Montserrat; Gisbert, Javier P.; Calvet, Xavier

doi:10.1016/s0016-5085(03)81819-x

Cited by 30 publications

(36 citation statements)

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“…The goal of adding a PPI to the antibiotics is to increase the pH to allow a better action of the latter. The different PPIs appear to have a similar adjuvant effect [24,25]. In the Maastricht-2 Consensus Report, there was also mention of RBC as an alternative to PPI [7].…”

Section: Modify the Drug Combinationmentioning

confidence: 99%

Update on therapeutic options for Helicobacter pylori-related diseases

Mégraud

2005

Curr Infect Dis Rep

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Triple therapy including clarithromycin, amoxicillin, and a proton pump inhibitor (PPI) has been recommended as the treatment of choice for Helicobacter pylori eradication. This regimen is now challenged by an increasing level of clarithromycin resistance that jeopardizes the treatment success. When clarithromycin resistance has been detected, or when its rate is known to be high in the geographic area, this drug cannot be used. It can be replaced by metronidazole, the resistance of which has a limited clinical relevance. Another option is to prescribe tetracycline and metronidazole with a PPI or ranitidine bismuth citrate. New antibiotics such as levofloxacin or rifabutin can also be used in combination with amoxicillin and a PPI. Probiotics can be added to all of these regimens to improve compliance by decreasing adverse events. But some authors advocate a quadruple therapy as a first-line treatment. Solutions to improve the limitations of this last regimen are now being proposed. Clarification of the controversial treatment indications such as gastroesophageal reflux disease or prevention of nonsteroidal anti-inflammatory drug gastroduodenal symptoms has been made. The question of prevention of gastric carcinoma by H. pylori eradication remains unanswered.

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Section: Modify the Drug Combinationmentioning

confidence: 99%

Update on therapeutic options for Helicobacter pylori-related diseases

Mégraud

2005

Curr Infect Dis Rep

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“…It is thus likely that in clinical practice no differences exist between the different PPIs when they are used in triple eradication regimens. The same conclusions arise from the results of two recent meta-analyses (20,21) where the authors found no differences in the efficacy of triple therapy when omeprazole was replaced by other PPIs expected to provide more potent acid inhibition, i.e., esomeprazole and rabeprazole.…”

Section: Discussionmentioning

confidence: 65%

“…Nevertheless, although many studies have been published (16)(17)(18)(19), it is still unclear whether different PPIs may vary in efficacy for H. pylori eradication. Two recent meta-analyses (20,21) found no differences in the efficacy of triple therapy when omeprazole was replaced by other PPIs expected to provide stronger acid inhibition. This suggests that, in triple therapy, omeprazole given twice daily is likely to achieve the optimal acid inhibition and that increasing antisecretory activity above this level would not enhance cure rates.…”

mentioning

confidence: 99%

Twice-Daily Standard Dose of Omeprazole Achieves the Necessary Level of Acid Inhibition for Helicobacter pylori Eradication. A Randomized Controlled Trial Using Standard and Double Doses of Omeprazole in Triple Therapy

Manes

Pieramico²,

Perri

et al. 2005

Dig Dis Sci

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Antibiotic resistances and level of acid inhibition may affect the outcome of eradicating regimens for H. pylori. To evaluate the impact of different degrees of acid inhibition on the efficacy of triple treatment, we treated 323 patients with H. pylori infection with clarithromycin and tinidazole plus omeprazole, either 20 mg bid or 40 mg bid. Gastric biopsies and antimicrobial susceptibility testing were performed. Eradication was evaluated by means of breath test. Eradication rates were (intention to treat and per protocol) 83.3 and 84.3% in patients receiving 40 mg omeprazole and 81.9 and 84.1% in those receiving 80 mg omeprazole. Culture was successful in 218 patients (68.7%). Resistance to clarithromycin and metronidazole were found in 13.7 and 20.6%, respectively. Eighteen further patients (8.2%) presented double resistance. Resistance was comparable across the two groups. In resistant patients the eradication rate was significantly lower (66.6% [95% CI, 56-76%], vs 86% [95% CI, 78-91%]; P = 0.001). Antibiotic resistance (OR, 2.73; 95% CI, 1.4-5.3) and smoking (OR, 2.68; 95% CI, 1.4-5.2) were independent predictors of eradication failure. Omeprazole, 20 mg bid, achieves the optimal acid inhibition in H. pylori eradication. Increasing antisecretory activity does not significantly enhance cure rates.

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“…Its successful eradication is therefore essential and strongly recommended in diagnosed patients and first-degree relatives of patients with gastric cancer. According to current European guidelines, triple therapy consisting of a proton-pump inhibitor (PPI), clarithromycin, and either amoxicillin or metronidazole is recommended as the first-line treatment [2,3]; nevertheless, the most successful treatment regimens have achieved eradication rates below 95% [4,5].…”

Section: Introductionmentioning

confidence: 99%