Comparative study of <i>Helicobacter pylori</i> eradication rates of concomitant therapy vs modified quadruple therapy comprising proton‐pump inhibitor, bismuth, amoxicillin, and metronidazole in Korea

Choe, Jung Wan; Jung, Sung Woo; Kim, Seung Young; Hyun, Jong Jin; Jung, Young Kul; Koo, Ja Seol; Yim, Hyung Joon; Lee, Sang Woo

doi:10.1111/hel.12466

Cited by 30 publications

(37 citation statements)

References 37 publications

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“…These results were even slightly higher than expected according to most recent studies that reported eradication rates ranging from 83% to 95% with CQT [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] and from 80% to 95% with BQT. Eradication rate obtained by both strategies was similar and clearly above the recommended 90% eradication rate (CQT 98.0% and BQT 94.4% at ITT analysis).…”

Section: The Addition Of Certain Probiotics (Different Lactobacillus Andcontrasting

confidence: 59%

“…Eradication rate obtained by both strategies was similar and clearly above the recommended 90% eradication rate (CQT 98.0% and BQT 94.4% at ITT analysis). These results were even slightly higher than expected according to most recent studies that reported eradication rates ranging from 83% to 95% with CQT [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] and from 80% to 95% with BQT. 25,[30][31][32][33][34][35][36][37][38][39] Since eradication rates of different therapies depend on the H pylori resistance pattern to antibiotics, our results are region specific and only applicable to areas with similar resistance rates to main antibiotics.…”

Section: The Addition Of Certain Probiotics (Different Lactobacillus Andcontrasting

confidence: 59%

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Bismuth‐containing quadruple therapy versus concomitant quadruple therapy as first‐line treatment for Helicobacter Pylori infection in an area of high resistance to clarithromycin: A prospective, cross‐sectional, comparative, open trial

et al. 2018

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Background Concomitant quadruple (CQT) or bismuth‐containing quadruple therapy (BQT) is recommended as first‐line treatment for Helicobacter pylori infection depending on antibiotic resistance. Aim To compare the efficacy, safety, and compliance of CQT and BQT as first‐line therapy for H. pylori eradication in real clinical practice in an area of high resistance to clarithromycin. Methods A prospective, open, comparative cross‐sectional study including dyspeptic patients >18 years with H. pylori infection and with no previous eradication treatment was performed. CQT (omeprazole 20 mg + clarithromycin 500 mg + amoxicillin 1 g + metronidazole 500 mg, all given twice daily, for 14 days) or BQT (omeprazole 20 mg twice daily + 3 capsules of Pylera® 4 times a day, for 10 days) was prescribed at the discretion of the prescribing physician. Eradication was tested by 13C‐urea breath test. Efficacy was assessed by intention‐to‐treat (ITT) and per‐protocol (PP) analyses. Results One hundred and four consecutive patients were included (64.4% female, age 52.9 years). Fifty patients received CQT and 54 BQT. Eradication rate was similar with both therapies at the PP (CQT 97.9%, 95% CI: 93.9‐100 vs BQT 96.2%, 95% CI: 90.9‐100, P = 0.605) and ITT analyses (CQT 98.0%, 95% CI: 94‐100 vs BQT 94.4%, 95% CI: 88.1‐100, P = 0.346). The rate of adverse events was also similar with CQT (56%) and BQT (46.3%). One patient in each group discontinued the treatment due to significant adverse events. Conclusion The use of CQT and BQT as first‐line treatment against H. pylori is similarly effective and safe strategy in an area of high clarithromycin resistance.

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Section: The Addition Of Certain Probiotics (Different Lactobacillus Andcontrasting

confidence: 59%

Section: The Addition Of Certain Probiotics (Different Lactobacillus Andcontrasting

confidence: 59%

Bismuth‐containing quadruple therapy versus concomitant quadruple therapy as first‐line treatment for Helicobacter Pylori infection in an area of high resistance to clarithromycin: A prospective, cross‐sectional, comparative, open trial

et al. 2018

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“…As reviewed in Table S7, some previous studies (most before 2008) showed that the bismuth quadruple therapy replacing tetracycline by amoxicillin had suboptimal results, possibly related to using low dose (≤2 g/d) of amoxicillin, low dose (≤1 g/d) of metronidazole, and/or a short duration of therapy (≤10 days) . Using higher doses of amoxicillin and metronidazole for 14 days the modified quadruple therapy has been shown to have good eradication efficacy in both previous studies (Table S7) and the present study. The ideal doses, duration and all components of this combination can only be identified using a factorial design.…”

Section: Discussionmentioning

confidence: 97%

“…The susceptibility‐based regimens consisted of clarithromycin, metronidazole or levofloxacin triple therapies for susceptible infections or a modified bismuth quadruple therapy for multidrug‐resistant infections. The comparator empiric therapy was locally proven highly effective empiric bismuth quadruple therapy containing amoxicillin and metronidazole …”

Section: Introductionmentioning

confidence: 99%

Randomised controlled trial: susceptibility‐guided therapy versus empiric bismuth quadruple therapy for first‐line Helicobacter pylori treatment

Chen¹,

Long²,

Ji³

et al. 2019

Aliment Pharmacol Ther

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Background:Increasing Helicobacter pylori resistance has led to decreases in treatment effectiveness.Aim: To test the effectiveness of susceptibility-guided therapy vs a locally highly effective empiric modified bismuth quadruple therapy for first-line H pylori treatment in a region with high antimicrobial resistance. Methods:We compared 14-day susceptibility-guided with empiric therapy using a multicentre superiority-design trial, which randomised H pylori infected subjects 3:1 to (a) susceptibility-guided therapies contained esomeprazole 20 mg and amoxicillin 1 g b.d. plus clarithromycin 500 mg, metronidazole 400 mg b.d., or levofloxacin 500 mg daily for susceptible infections or bismuth 220 mg b.d. and metronidazole 400 mg q.d.s. for triple-resistant infections; (b) Empiric therapy contained esomeprazole 20 mg, bismuth 220 mg b.d., amoxicillin 1 g and metronidazole 400 mg t.d.s.Primary outcome was H pylori eradication. Results: Between February 2017 and March 2018, 491 subjects were screened and 382 were randomised. Both the susceptibility-guided and the empiric regimens were highly successful with per-protocol eradication rates of 97.7% (250/256) vs 97.6% (81/83, P = 1.00) and intent-to-treat eradication rates of 91.6% (262/286) vs 85.4%(82/96, P = 0.12). Overall, susceptibility-guided therapy was not superior to empiric therapy with 0.1% per-protocol (95% CI −3.1% to 3.2%) and 6.2% intent-to-treat (−0.3% to 12.7%) eradication difference. Both approaches had high adherence and low adverse event rates.Conclusions: Both susceptibility-guided and empiric therapies provided excellent eradication rates. Clinically, the choice would hinge on availability of susceptibility testing and/or a locally highly effective empiric therapy. S U PP O RTI N G I N FO R M ATI O NAdditional supporting information will be found online in the Supporting Information section at the end of the article.How to cite this article: Chen Q, Long X, Ji Y, et al.Randomised controlled trial: susceptibility-guided therapy versus empiric bismuth quadruple therapy for first-line Helicobacter pylori treatment. Aliment Pharmacol Ther.

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“…69 Neither an extension to the duration of sequential treatment to 14 days nor the addition of bismuth improved eradication rates. 70 In Korea, where high levels of clarithromycin resistance have been reported, 10-day concomitant therapy achieved eradication rates in excess of 95% in per protocol analysis 71 and proved superior to sequential therapy in terms of efficacy. 72 A systematic review and meta-analysis compared the efficacy and safety of concomitant and sequential therapy.…”

Section: S Equential and Con Comitant Ther Apymentioning

confidence: 99%

Treatment of Helicobacter pylori infection in 2018

et al. 2018

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Treatment options for the eradication of Helicobacter pylori continue to evolve. There have been many guidelines for H. pylori treatment published, which may lead to some confusion. However, most are in agreement with the most recent iteration of the Maastricht treatment guidelines. Triple therapy is still the most frequently used treatment, especially in areas of low clarithromycin resistance. Its best results are achieved when taken for a minimum of 10 days and with high-dose acid suppression. Quadruple therapy is gaining in popularity particularly in areas with increasing resistance to standard triple therapy. Whether three antibiotics, or bismuth and two antibiotics are used, excellent eradication rates are achieved, albeit with increased side effects. Levofloxacin second-line therapy is widely used; however bismuth, when available, is an increasingly successful option. Sequential therapy is challenging in terms of compliance and is no longer recommended. This past year witnessed a notable increase in the number of studies based on antimicrobial susceptibility testing and tailored eradication therapy, reflecting the role of culture-guided treatment, which may well represent the future of H. pylori treatment and prevent the inappropriate use of antibiotics.

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Comparative study of Helicobacter pylori eradication rates of concomitant therapy vs modified quadruple therapy comprising proton‐pump inhibitor, bismuth, amoxicillin, and metronidazole in Korea

Abstract: PAM-B therapy is as effective as concomitant therapy for eradicating H. pylori with comparative safety. PAM-B therapy is regarded as a promising alternative to standard triple therapy for a first-line eradication in Korea.

Cited by 30 publications

References 37 publications

Bismuth‐containing quadruple therapy versus concomitant quadruple therapy as first‐line treatment for Helicobacter Pylori infection in an area of high resistance to clarithromycin: A prospective, cross‐sectional, comparative, open trial

Bismuth‐containing quadruple therapy versus concomitant quadruple therapy as first‐line treatment for Helicobacter Pylori infection in an area of high resistance to clarithromycin: A prospective, cross‐sectional, comparative, open trial

Randomised controlled trial: susceptibility‐guided therapy versus empiric bismuth quadruple therapy for first‐line Helicobacter pylori treatment

Treatment of Helicobacter pylori infection in 2018

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