Comparison of the efficacy of culture-based tailored therapy for<i>Helicobacter pylori</i>eradication with that of the traditional second-line rescue therapy in Korean patients: a prospective single tertiary center study

Kwon, Yong Hwan; Kim, Nayoung; Lee, Ju Yup; Choi, Yoon Jin; Yoon, Kichul; Nam, Ryung Hee; Suh, Ji Hyung; Lee, Jung Won; Lee, Dong Hoon

doi:10.3109/00365521.2015.1095352

Cited by 28 publications

(61 citation statements)

References 30 publications

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“…Figure 1 details the procedure of study selection in the flow chart. Thirteen studies [13][14][15][16][17][18][19][20][21][22][23][24][25] were qualified in this meta-analysis. Tables 1 and 2 set 2 different control groups, respectively, which were labeled as group a and b in our study (e.g., Lee a and Lee b).…”

Section: Statistical Analysesmentioning

confidence: 99%

“…Ten tailored regimens [14][15][16][17]19,[21][22][23][24][25] were designed according to pretreatment susceptibility testing (pooled RR ¼ 1.17, 95% CI 1.11-1.24). Three other studies 13,18,20 advanced their susceptibility-guided therapy by additionally adjusting their PPI administration (either by dosage adjustments or by changing drugs) on the basis of CYP2C19 polymorphism (pooled RR ¼ 1.14, 95% CI 1.01-1.28).…”

Section: Types Of Tailored Regimensmentioning

confidence: 99%

“…Nine studies designed first-line tailored therapy, whereas 3 studies 21,22,25 applied salvage tailored therapy. One trial 17 performed tailored regimen as both first-line and rescue therapy.…”

Section: First-line and Nonfirst-line Tailored Therapymentioning

confidence: 99%

“…Different adjectives have been used to describe it as tailored, personalized, individualized, culture-based, pharmacogenetic-based, and susceptibilityguided. [13][14][15][16][17][18][19][20][21][22][23][24][25] This attributes to the fact that multiple factors will affect the final eradication success. 1,6 These factors include antibiotic resistance, dosing of acid inhibitory drugs, genotypes of drug-metabolizing enzymes, drug transporters, inflammatory cytokines (i.e., interleukin [IL]-1b), one's past medical history, treatment tolerance, and also personal compliance.…”

Section: Summary Of Evidencementioning

confidence: 99%

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318 Tailored Therapy Versus Empiric Chosen Treatment for Helicobacter pylori Eradication: A Meta-Analysis

Chen¹,

Dang²,

Zhou³

et al. 2016

Gastroenterology

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Section: Statistical Analysesmentioning

confidence: 99%

Section: Types Of Tailored Regimensmentioning

confidence: 99%

Section: First-line and Nonfirst-line Tailored Therapymentioning

confidence: 99%

Section: Summary Of Evidencementioning

confidence: 99%

See 2 more Smart Citations

318 Tailored Therapy Versus Empiric Chosen Treatment for Helicobacter pylori Eradication: A Meta-Analysis

Chen¹,

Dang²,

Zhou³

et al. 2016

Gastroenterology

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“…However, a study has shown that antimicrobial susceptibility-guided therapy is more effective than empiric concomi- Patients that completed study protocol (n = 60) tant therapy with fewer adverse effects (28). The superiority of a tailored therapy as a second-line approach was also demonstrated by a South-Korean prospective study (29). Furthermore, it may also prove to be a cost-effective strategy in high clarithromycin resistance regions (30,31).…”

Section: Discussionmentioning

confidence: 99%

Twelve-day quintuple regime containing four antibiotics as a rescue therapy for Helicobacter pylori eradication in the central region of Portugal

et al. 2017

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Background: Helicobacter pylori eradication rates with standard triple therapy in many countries are clinically unacceptable. Fluoroquinolone resistance is increasing and jeopardizing secondline regimens. There is a growing need for an effective strategy in patients who failed previous therapies.Methods: This is a single-center, non-randomized clinical study conducted in the central region of Portugal. Sixty-four patients were included with a positive 13 C-urea breath test (UBT) or histology for H. pylori, and at least one failed eradication attempt. The patient cohort included 71.7% of females with a median of age of 52 (range 23-87). They were treated with a twelve-day regimen consisting of a proton-pump inhibitor (PPI) bid, amoxicillin at 1,000 mg 12/12h and levofloxacin at 500 mg bid during the first seven days, followed by PPI bid, clarithromycin at 500 mg 12/12 h and either tinidazole or metronidazole at 500 mg bid/tid for five days. Eradication was assessed by UBT. The local Ethics Committee approved this study.Results: Eradication therapy was prescribed due to dyspepsia (66.7%), peptic ulcer (10%) and thrombocytopenia (8.3%). The median number of failed therapies was one (range 1-4). The eradication rate was 64.6% according to an intention-to-treat analysis (95% CI: 53-77%), and 70% by the per-protocol analysis (95% CI: 58-82%). Age, smoking, indication for eradication, previous therapies and the use of a second-generation or full-dose PPI did not affect success rates.Conclusions: Even though treatment with four antibiotics was used, this "reinforced" therapy achieved suboptimal results. This fact highlights the lack of effective H. pylori antimicrobials and suggests that second-line treatment in our region should be prescribed according to susceptibility testing.

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Tailored Therapy Versus Empiric Chosen Treatment for Helicobacter pylori Eradication

et al. 2016

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Although various regimens are empirically accepted for Helicobacter pylori eradication, the efficacy might be declined by multiple individual factors. The necessity of a personalized eradication therapy still remains controversial. The aim of the study was to compare tailored therapy with empiric chosen regimens.Databases of PUBMED, EMBASE, and MEDLINE were searched for eligible studies, published up to October 2015. All relevant controlled clinical trials were included. A random-effect model was applied to compare pooled relative risk (RR) with related 95% confidence intervals (CIs).Thirteen controlled clinical trials integrating 3512 participants were assessed. Overall, the pooled eradication rates of tailored groups were higher than those of empiric ones (intention-to-treat: RR = 1.16, 95% CI 1.10–1.22; preprotocol: RR = 1.14, 95% CI 1.08–1.21). In subgroup analysis, tailored therapy was superior to 7-day standard triple therapy (RR = 1.22, 95% CI 1.16–1.29) and bismuth-quadruple therapy (RR = 1.14, 95% CI 1.07–1.22) on eradication rates; first-line tailored therapy achieved higher eradication rates than first-line empirical regimens (pooled RR = 1.18, 95%CI 1.14–1.22), whereas tailored rescue regimen showed no difference with empirical ones (pooled RR = 1.16, 95% CI 0.96–1.39). Moreover, among different tailored designs, susceptibility-guided tailored therapy obtained higher eradication rates than empiric groups, independent of CYP2C19 genotype detection (with CYP: RR = 1.16, 95% CI 1.09–1.23; without CYP: RR = 1.14, 95% CI 1.01–1.28). Both molecular test-based and culture-based tailored groups were better on eradication rates than empiric groups (molecular: RR = 1.23, 95% CI 1.11–1.35; culture: RR = 1.13, 95% CI 1.06–1.20).Compared with empiric chosen treatments, tailored therapy is a better alternative for H pylori eradication.

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Comparison of the efficacy of culture-based tailored therapy forHelicobacter pylorieradication with that of the traditional second-line rescue therapy in Korean patients: a prospective single tertiary center study

Abstract: Tailored therapy based on H. pylori culture and MIC test could be an option as a second-line eradication regimen in the presence of high level of antimicrobial resistance.

Cited by 28 publications

References 30 publications

318 Tailored Therapy Versus Empiric Chosen Treatment for Helicobacter pylori Eradication: A Meta-Analysis

318 Tailored Therapy Versus Empiric Chosen Treatment for Helicobacter pylori Eradication: A Meta-Analysis

Twelve-day quintuple regime containing four antibiotics as a rescue therapy for Helicobacter pylori eradication in the central region of Portugal

Tailored Therapy Versus Empiric Chosen Treatment for Helicobacter pylori Eradication

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