Comparison of 10-Day Course of Triple Therapy Versus 14-Day Course for Eradication of Helicobacter pylori Infection in an Indonesian Population: Double-Blinded Randomized Clinical Trial

Herardi, Ryan; Syam, Ari Fahrial; Simadibrata, Marcellus; Setiati, Siti; Darnindro, Nikko; Abdullah, Murdani; Makmun, Dadang

doi:10.31557/apjcp.2020.21.1.19

Cited by 9 publications

(10 citation statements)

References 15 publications

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“…Theoretically, standard triple therapy could be used (less than 15% resistant of clarithromycin) [2]. However, a recent clinical trial in Indonesia using the standard triple therapy for 10 days only obtained a 67.6% cure rate of intention to treat (ITT) [21]. This value is much lower than the ideal ITT for the regimen; 90-95% [22,23].…”

Section: Introductionmentioning

confidence: 99%

Biofilm Formation and Antibiotic Resistance Phenotype of Helicobacter pylori Clinical Isolates

Fauzia

Miftahussurur

Syam

et al. 2020

Toxins

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We evaluated biofilm formation of clinical Helicobacter pylori isolates from Indonesia and its relation to antibiotic resistance. We determined the minimum inhibition concentration (MIC) of amoxicillin, clarithromycin, levofloxacin, metronidazole and tetracycline by the Etest to measure the planktonic susceptibility of 101 H. pylori strains. Biofilms were quantified by the crystal violet method. The minimum biofilm eradication concentration (MBEC) was obtained by measuring the survival of bacteria in a biofilm after exposure to antibiotics. The majority of the strains formed a biofilm (93.1% (94/101)), including weak (75.5%) and strong (24.5%) biofilm-formers. Planktonic resistant and sensitive strains produced relatively equal amounts of biofilms. The resistance proportion, shown by the MBEC measurement, was higher in the strong biofilm group for all antibiotics compared to the weak biofilm group, especially for clarithromycin (p = 0.002). Several cases showed sensitivity by the MIC measurement, but resistance according to the MBEC measurements (amoxicillin, 47.6%; tetracycline, 57.1%; clarithromycin, 19.0%; levofloxacin, 38.1%; and metronidazole 38.1%). Thus, biofilm formation may increase the survival of H. pylori and its resistance to antibiotics. Biofilm-related antibiotic resistance should be evaluated with antibiotic susceptibility.

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Section: Introductionmentioning

confidence: 99%

Biofilm Formation and Antibiotic Resistance Phenotype of Helicobacter pylori Clinical Isolates

Fauzia

Miftahussurur

Syam

et al. 2020

Toxins

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“…A meta‐analysis of 45 studies from Turkey was in agreement with just 60% achieving eradication with both 7‐ and 14‐day regimens 9 . In Indonesia, however, a 14‐day TT regimen was significantly more effective than a 10 day TT (87% vs 68%) 10 . Two meta‐analyses addressed the question of whether TT with clarithromycin or metronidazole was more effective 11,12 .…”

Section: Triple Therapymentioning

confidence: 79%

Review – Treatment of Helicobacter pylori infection 2020

et al. 2020

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This review summarizes important studies regarding Helicobacter pylori therapy published from April 2019 to April 2020. The main themes that emerge involve studies assessing antibiotic resistance, and there is also growing momentum behind the utility of vonoprazan as an alternative to proton pump inhibitor (PPI) therapy and also bismuth‐based regimens as a first‐line regimen. Antibiotic resistance is rising wherever it is being assessed, and clarithromycin resistance in particular has reached a point where it may no longer be a viable therapy without previous testing in many regions of the world. The evidence for the efficacy of a bismuth‐based quadruple therapy as a first‐line therapy is now very clearly established, and there is substantial evidence that it is the best performing first‐line therapy. The utility of vonoprazan as an alternative to PPI therapy, especially in resistant and difficult‐to‐treat groups, has also been considered in great detail this year, and it may offer an opportunity in the near future to reduce the problem of antibiotic resistance.

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“…Current consensus recommends that eradication therapy should be implemented as long as H. pylori infection is detected, unless there are competing considerations, the initial therapy should achieve an ideal eradication success 5,11 . Successful initial eradication can avoid subsequent repeated treatment and testing, reducing medical costs, self‐anxiety, and negative effects on gut microbiota 29 …”

Section: Discussionmentioning

confidence: 99%

“…5,11 Successful initial eradication can avoid subsequent repeated treatment and testing, reducing medical costs, self-anxiety, and negative effects on gut microbiota 29. T A B L E 1 (Continued) Abbreviations: CI, confidence interval; ITT, intention-to treat; PP, per-protocol; RD, rate difference.T A B L E 3…”

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confidence: 99%

Efficacy and safety of triple therapy containing berberine hydrochloride, amoxicillin, and rabeprazole in the eradication of Helicobacter pylori

Chen

et al. 2022

J of Digest Diseases

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Objective To estimate the effectiveness and safety of triple therapy containing berberine, amoxicillin, and rabeprazole in the eradication of Helicobacter pylori (H. pylori). Methods This prospective, randomized controlled, open‐label, noninferiority trial included treatment‐naive patients with H. pylori infection who were randomly allocated at a ratio of 1:1 into the berberine triple therapy group (berberine hydrochloride 300 mg thrice daily, amoxicillin 1 g twice daily, and rabeprazole 10 mg twice daily) or standard bismuth‐containing quadruple therapy group (amoxicillin 1 g twice daily, rabeprazole 10 mg twice daily, clarithromycin 500 mg twice daily, and bismuth tartrate 200 mg twice daily) for 14 days. Negative 13C/14C‐urea breath test at 4 weeks after completion of the therapy was regarded as successful eradication. Results Altogether 262 and 262 patients received berberine triple therapy and bismuth‐containing quadruple therapy, respectively. Both intention‐to‐treat (79.8% vs 80.9%, P = 0.742) and per‐protocol analyses (83.6% and 85.1%, P = 0.636) showed comparable eradication rate between the two groups, indicating a noninferior eradication rate (the lower limit of the 95% confidence interval over −10% [−7.9% and −7.87%, respectively]). Adverse events more commonly occurred in the bismuth‐containing quadruple‐therapy group (8.8% vs 16.0%, P = 0.012), while patient compliance and symptom improvement of the two regimens were comparable. Conclusion Triple therapy containing berberine, amoxicillin and rabeprazole is noninferior to bismuth‐containing quadruple therapy in the initial treatment for H. pylori eradication.

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Comparison of 10-Day Course of Triple Therapy Versus 14-Day Course for Eradication of Helicobacter pylori Infection in an Indonesian Population: Double-Blinded Randomized Clinical Trial

Abstract: recommend triple therapy, consist of proton pump inhibitor, Amoxicillin, and Clarithromycin, for the first-line therapy of H. pylori infection. Yet, questions remain regarding the optimal duration of triple therapy. For Asia, APAGE and PGI

Cited by 9 publications

References 15 publications

Biofilm Formation and Antibiotic Resistance Phenotype of Helicobacter pylori Clinical Isolates

Biofilm Formation and Antibiotic Resistance Phenotype of Helicobacter pylori Clinical Isolates

Review – Treatment of Helicobacter pylori infection 2020

Efficacy and safety of triple therapy containing berberine hydrochloride, amoxicillin, and rabeprazole in the eradication of Helicobacter pylori

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