Culture-based Selection Therapy for Patients Who Did Not Respond to Previous Treatment for Helicobacter pylori Infection

Fiorini, Giulia; Vakil, Nimish; Zullo, Angelo; Saracino, Ilaria Maria; Castelli, Vincenzo Parenti; Ricci, Chiara; Zaccaro, Cristina; Gatta, Luigi; Vaira, Dino

doi:10.1016/j.cgh.2012.12.007

Cited by 56 publications

(58 citation statements)

References 18 publications

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“…Fiorini et al also pointed out that a high dose of PPI might increase the intra-gastric concentration of rifabutin by decreasing gastric volume. 24 Goh et al reported that the eradication rate of high-dose rabeprazole-amoxicillin dual therapy (amoxicillin 3000 mg, rabeprazole 60 mg for two weeks) was 71.4% as rescue therapy. 25 Attumi et al performed the eradication rate of high-dose dexlansoprazole and amoxicillin dual therapy (amoxicillin 2000 mg, dexlansoprazole 240 mg for two weeks) was 53.8%.…”

Section: Discussionmentioning

confidence: 99%

Rifabutin-based 10-day and 14-day triple therapy as a third-line and fourth-line regimen forHelicobacter pylorieradication: A pilot study

Mori

Suzuki

Matsuzaki

et al. 2015

United European Gastroenterology Journal

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Background and aim: This prospective randomized study was designed to assess the efficacy of 10-day and 14-day rifabutinbased triple therapy as a third-or fourth-line rescue therapy. Methods: Patients who failed first-and second-line eradication therapy were enrolled. H. pylori was isolated from gastric biopsy specimens and the rpoB mutation status, a factor of resistance to rifamycins, and minimum inhibitory concentrations (MICs) of rifabutin and amoxicillin were determined. Enrolled patients were randomly assigned to receive 10-day or 14-day eradication therapy with esomeprazole (20 mg, 4 times a day (q.i.d.)), amoxicillin (500 mg, q.i.d.), and rifabutin (300 mg, once a day (q.d.s.)). Poor compliance was defined as intake of <80% of study drugs. Successful H. pylori eradication was confirmed using a [13C] urea breath test or a stool antigen test, 12 weeks after the end of therapy. Results: Twelve patients were assigned to the 10-day group, and 17, to the 14-day group. Intention-to-treat and per-protocol analyses of eradication rates were 83.3% and 81.8% for the 10-day group and 94.1% and 91.7% for the 14-day group, respectively. All patients with rpoB mutation-positive strains (n ¼ 3) showed successful eradication, irrespective of the regimen received. Therapy was stopped due to adverse events in 8.3% and 29.3% of patients in the 10-day and 14-day groups, respectively. Conclusion: Both the 10-day and 14-day therapies were effective as rescue regimens. In particular, the 14-day therapy resulted in successful eradication in over 90% of patients, but the 10-day treatment may be enough to obtain a successful eradication rate, considering the tolerability of therapy.

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Section: Discussionmentioning

confidence: 99%

Rifabutin-based 10-day and 14-day triple therapy as a third-line and fourth-line regimen forHelicobacter pylorieradication: A pilot study

Mori

Suzuki

Matsuzaki

et al. 2015

United European Gastroenterology Journal

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“…In Italy, Fiorini and colleagues included 254 patients who failed at least one standard therapy for H. pylori eradication and underwent an upper endoscopy [Fiorini et al 2013]. A total of 44% had failed at least two treatment attempts.…”

Section: Studies Included Reporting Cure Rates Of Sgt In Third-line Tmentioning

confidence: 99%

“…Cammarota and colleagues reported poor tolerance of quadruple bismuth therapy, and 1 out of 94 patients abandoned treatment due to severe side effects [Cammarota et al 2004]; Liou and colleagues reported a dropout rate of 1% due to side effects [Liou et al 2013]; and Vicente and colleagues reported no severe adverse events or dropouts [Vicente et al 2002]. Fiorini and colleagues reported mild-tomoderate side effects in 15% and 20% of patients in each treatment arm; however, all patients complied with at least 90% of the treatment [Fiorini et al 2013]. Gasbarrini and colleagues, Tay and coworkers and Yahav's group did not mention the number of patients with adverse events, though the latter author reported a treatment compliance of 97% [Gasbarrini et al 2000;Tay et al 2012;Yahav et al 2006].…”

Section: Safety and Side Effectsmentioning

confidence: 99%

Systematic review: third-line susceptibility-guided treatment for Helicobacter pylori infection

Puig

López-Góngora

Calvet

et al. 2016

Therap Adv Gastroenterol

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Background: Susceptibility-guided therapies (SGTs) have been proposed as preferable to empirical rescue treatments after two treatment failures. The aim of this study was to perform a systematic review and meta-analysis evaluating the effectiveness and efficacy of SGT as third-line therapy. Methods: A systematic search was performed in multiple databases. Studies reporting cure rates of Helicobacter pylori with SGT in third-line therapy were selected. A qualitative analysis describing the current evidence and a pooled mean analysis summarizing the cure rates of SGT in third-line therapy was performed. Results: No randomized controlled trials or comparative studies were found. Four observational studies reported cure rates with SGT in third-line treatment, and three studies which mixed patients with second-and third-line treatment also reported cure rates with SGT. The majority of the studies included the patients when culture had been already obtained, and so the effectiveness of SGT and empirical therapy has never been compared. A pooled mean analysis including four observational studies (283 patients) showed intention-to-treat and perprotocol eradication rates with SGT of 72% (95% confidence interval 56-87%; I 2 : 92%) and 80% (95% confidence interval 71-90%; I 2 : 80%), respectively. Conclusions: SGT may be an acceptable option as rescue treatment. However, cure rates are, at best, moderate and this approach has never been compared with a well-devised empirical therapy. The evidence in favor of SGT as rescue therapy is currently insufficient to recommend its use.

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“…culture [2]. However, despite the fact that this technique may permit the achievement of good eradication rates [4], culture is not feasible everywhere and di cult to perform even in expert hands. Moreover, the limited number of effective antibiotics against the bacterium narrows the eld of options.…”

Section: Introductionmentioning

confidence: 99%

Quadruple Rescue erapy aer First and Second Line Failure for Helicobacter pylori Treatment: Comparison between Two Tetracycline-Based Regimens

Ierardi

Giangaspero

Losurdo

et al. 2014

JGLD

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Background & Aims: Antibiotic resistance is the main reason for failure of Helicobacter pylori (H. pylori) treatment. Currently, guidelines recommend a treatment guided by antimicrobial susceptibility testing after two failures. However, microbial culture is not feasible everywhere, and the limited number of effective antibiotics against the bacterium narrows the options; thus a rescue therapy combining antibiotics with a low resistance may be fitting.Methods: Patients who have failed a first-line treatment (either prolonged triple or sequential regimens) and, successively, a levofloxacin-based triple therapy were considered for the study. Subjects underwent urea breath test (UBT), stool antigen test (ST) and endoscopy/histology to confirm the diagnosis. Cytopenia and impaired liver and kidney function were exclusion criteria. Fifty-four subjects were randomized 1:1 to two regimens: RMB Rabeprazole/Rifabutin/Minocycline/Bismuth sub-citrate or MTB Rabeprazole/Tinidazole/ Minocycline/Bismuth sub-citrate both for 10 days. The results were checked 6 weeks after the end of therapy with ST/UBT plus endoscopy when indicated.Results: RMB eradicated the bacterium in 21 patients. Two subjects dropped out. The eradication rate was 77.7% (CI 62.0-93.4%) at intention-to-treat and 84.0% (CI 69.6-98.4%) at per-protocol analysis. MTB was successful in 14 patients (51.9%, CI 33.1-70.7%). No patient withdrew from the treatment for adverse events. Drug-related side effects were reported only in 3 subjects, but in all cases the treatment was carried on.Conclusions: The association minocycline/rifabutin seems to have a synergic effect and a good therapeutic outcome in patients who have failed at least two previous regimens, although a trial on a large population is needed.

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Culture-based Selection Therapy for Patients Who Did Not Respond to Previous Treatment for Helicobacter pylori Infection

Cited by 56 publications

References 18 publications

Rifabutin-based 10-day and 14-day triple therapy as a third-line and fourth-line regimen forHelicobacter pylorieradication: A pilot study

Rifabutin-based 10-day and 14-day triple therapy as a third-line and fourth-line regimen forHelicobacter pylorieradication: A pilot study

Systematic review: third-line susceptibility-guided treatment for Helicobacter pylori infection

Quadruple Rescue erapy aer First and Second Line Failure for Helicobacter pylori Treatment: Comparison between Two Tetracycline-Based Regimens

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