Dual proton pump inhibitor plus amoxicillin as an empiric anti-H. pylori therapy: studies from the United States

Graham, David Y.; Javed, Syed Ussama; Keihanian, Sara; Abudayyeh, Suhaib; Opekun, Antone R.

doi:10.1007/s00535-010-0220-x

Cited by 59 publications

(49 citation statements)

References 47 publications

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“…This influenced concomitant therapy, although not drastically, eradicating the majority (70%) of such strains as first‐line therapy. This percentage is much greater than the expected by single effect of the remaining drugs (PPI and AMO 1gr bid for 10 days) . Thus, it could be speculated a synergistic effect among all three antibiotics along with the additive effects of double dose of a powerful new generation PPI (esomeprazole) included in this regimen .…”

Section: Discussionmentioning

confidence: 79%

Clinical Evaluation of a Ten‐Day Regimen with Esomeprazole, Metronidazole, Amoxicillin, and Clarithromycin for the Eradication of Helicobacter pylori in a High Clarithromycin Resistance Area

Georgopoulos¹,

Xirouchakis²,

Martinez-Gonzalez

et al. 2013

Helicobacter

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Section: Discussionmentioning

confidence: 79%

Clinical Evaluation of a Ten‐Day Regimen with Esomeprazole, Metronidazole, Amoxicillin, and Clarithromycin for the Eradication of Helicobacter pylori in a High Clarithromycin Resistance Area

Georgopoulos¹,

Xirouchakis²,

Martinez-Gonzalez

et al. 2013

Helicobacter

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“…The old dual regimen of a PPI plus amoxicillin given twice daily (and abandoned because of low eradication rates (<50%)), returns nowadays with the administration of higher doses of both drugs (PPI × 3 and amoxicillin 1000 mg × 3). With the new dosing scheme this dual regimen can be used as salvage therapy in areas with high resistance rates to levofloxacin [108]. The small minority of patients (<1%) with refractory H. pylori infection to both first- and second-line treatments have to be referred for antibiotic susceptibility testing in order for third-line therapies to be instituted [104, 109].…”

Section: Therapeutic Algorithm Of H Pylori Infection In Clinicalmentioning

confidence: 99%

Helicobacter pyloriEradication Therapies in the Era of Increasing Antibiotic Resistance: A Paradigm Shift to Improved Efficacy

Georgopoulos

Papastergiou

Karatapanis

2012

Gastroenterology Research and Practice

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With the rising prevalence of antimicrobial resistance, the eradication rates ofHelicobacter pylori (H. pylori)with standard treatments are decreasing to unacceptable levels (i.e., ≤80%) in most countries. After these disappointing results, several authorities have proposed that infection withH. pylorishould be approached and treated as any other bacterial infectious disease. This implicates that clinicians should prescribe empirical treatments yielding a per protocol eradication of at least 90%. In recent years several treatments producing ≥90% cure rates have been proposed including sequential therapy, concomitant quadruple therapy, hybrid (dual-concomitant) therapy, and bismuth-containing quadruple therapy. These treatments are likely to represent the recommended first-line treatments in the near future. In the present paper, we are considering a series of critical issues regarding currently available means and approaches for the management ofH. pyloriinfection. Clinical needs and realistic endpoints are taken into account. Furthermore, emerging strategies for the eradication ofH. pyloriand the existing evidence of their clinical validation and widespread applicability are discussed.

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“…These results show that increased acid inhibition by PPIs may enable dual therapy, and this can be achieved by increasing the amount of time that this type of drug is in the blood. However, there have been several attempts at dual therapy with lack of success, likely due to inadequate elevation of pH during the night 34, 35 .…”

Section: Discussionmentioning

confidence: 99%

The effects of varying acidity on Helicobacter pylori growth and the bactericidal efficacy of ampicillin

Marcus

Inatomi

Nagami

et al. 2012

Aliment Pharmacol Ther

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Summary Background Penicillins inhibit cell wall synthesis; therefore, H. pylori must be dividing for this class of antibiotics to be effective in eradication therapy. Identifying growth responses to varying medium pH may allow design of more effective treatment regimens. Aim To determine the effect of acidity on bacterial growth and the bactericidal efficacy of ampicillin. Methods H. pylori were incubated in dialysis chambers suspended in 1.5L of media at various pHs with 5mM urea, with or without ampicillin, for 4, 8 or 16 hours, thus mimicking unbuffered gastric juice. Changes in gene expression, viability and survival were determined. Results At pH 3.0, but not at pH 4.5 or 7.4, there was decreased expression of ~400 genes, including many cell envelope biosynthesis, cell division and penicillin-binding protein genes. Ampicillin was bactericidal at pH 4.5 and 7.4 but not at pH 3.0. Conclusion Ampicillin is bactericidal at pH 4.5 and 7.4, but not at pH 3.0, due to decreased expression of cell envelope and division genes with loss of cell division at pH 3.0. Therefore, at pH 3.0, the likely pH at the gastric surface, the bacteria are non-dividing and persist with ampicillin treatment. A more effective inhibitor of acid secretion that maintains gastric pH near neutrality for 24 hours/day should enhance the efficacy of amoxicillin, improving triple therapy and likely even allowing dual amoxicillin based therapy for H. pylori eradication.

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Dual proton pump inhibitor plus amoxicillin as an empiric anti-H. pylori therapy: studies from the United States

Cited by 59 publications

References 47 publications

Clinical Evaluation of a Ten‐Day Regimen with Esomeprazole, Metronidazole, Amoxicillin, and Clarithromycin for the Eradication of Helicobacter pylori in a High Clarithromycin Resistance Area

Clinical Evaluation of a Ten‐Day Regimen with Esomeprazole, Metronidazole, Amoxicillin, and Clarithromycin for the Eradication of Helicobacter pylori in a High Clarithromycin Resistance Area

Helicobacter pyloriEradication Therapies in the Era of Increasing Antibiotic Resistance: A Paradigm Shift to Improved Efficacy

The effects of varying acidity on Helicobacter pylori growth and the bactericidal efficacy of ampicillin

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