Efficacy of Helicobacter pylori eradication therapies: a single centre observational study

Beales, Ian

doi:10.1186/1471-230x-1-7

Cited by 65 publications

(77 citation statements)

References 32 publications

(34 reference statements)

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“…Side effects were minimal in the two studies. Beal et al used a rifabutin-based regime in H. pylori strains resistant to both metronidazole and clarithromycin, which resulted in a 60% eradication rate (16). Canducci et al used a 10-day regime consisting of omeprazole, amoxycillin, and rifabutin resulting in a 70% eradication rate.…”

Section: Discussionmentioning

confidence: 98%

Efficacy and Tolerability of Rifampicin-Based Rescue Therapy for Helicobacter Pylori Eradication Failure in Peptic Ulcer Disease

et al. 2005

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In vitro activity of rifampicin has been shown against H. pylori. It has also been reported that the prevalence of H. pylori is low in patients with tuberculosis treated with rifampicin. Clinical trials are required to establish the efficacy of rifampicin as a salvage therapy for eradication of H. pylori. We aimed to evaluate the efficacy of rifampicin-based salvage therapy for eradication of H. pylori in patients with peptic ulcer disease. Twenty-eight patients with peptic ulcer disease who either had failed eradication of H. pylori or had a recurrence of H. pylori following successful eradication were included in the prospective study. The inclusion criteria included one or more failed attempts at eradication and presence of H. pylori infection as evidenced by positivity of at least two of three tests: rapid urease test (RUT), 14C urea breath test (UBT), and histology. The subjects were treated with a 10-day regimen consisting of rifampicin, 450 mg od, tetracycline, 1 g bd, and esomeprazole, 40 mg bd. Four weeks after completion of therapy, H. pylori status was assessed by RUT, 14C, UBT, and histology. Liver function tests were done before and at the end of therapy. The study subjects included 25 males and 3 females with a mean age of 33.7+/-8.92 years (range: 22-65 years). The median duration of symptoms was 42 months, with a range of 1-180 months. The median number of eradication attempts was two, with one prior attempt in 6 (21.4%), two attempts in 19 (67.9%), and three attempts in 3 (10.7%) patients. Successful H. pylori eradication as defined by concomitant negativity of RUT, UBT, and histology with special stains was achieved in 32.1% (9/28) of patients by intention-to-treat and 33.3% (9/27) of patients by per-protocol analysis. This pilot study suggests that rifampicin-based regimes have no role as salvage eradication therapy in refractory cases of H. pylori infection with peptic ulcer disease.

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Section: Discussionmentioning

confidence: 98%

Efficacy and Tolerability of Rifampicin-Based Rescue Therapy for Helicobacter Pylori Eradication Failure in Peptic Ulcer Disease

et al. 2005

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“…Some authors have demonstrated that initial regimens containing both clarithromycin and nitroimidazole are associated with significantly worse results overall, with lower eradication rates after logically chosen second-line therapy and sensitivity-directed third-line therapy. These poor results were due to the emergence of multiple resistant strains, as evidenced by the results of culture testing after the second failed course [9]. Thus, endoscopy with culture and susceptibility testing would seem to be essential after failure if PPI-clarithromycin-metronidazole regimen is prescribed initially [3].…”

Section: Opinion Statementmentioning

confidence: 99%

Treatment of helicobacter pylori eradication failures

Gisbert

2003

Curr Treat Options Gastro

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Even with the current most effective treatment regimens, about 10% to 20% of patients will fail to eradicate Helicobacter pylori infection. Therefore, in designing a treatment strategy, we should not focus on the results of primary therapy alone but also on the final (overall) eradication rate. The choice of a second-line treatment depends on which treatment was used initially, because retreatment with the same regimen is not recommended. Therefore, it seems that performing culture after a first eradication failure is not necessary and assessing H. pylori sensitivity to antibiotics only after failure of the second treatment is suggested in clinical practice. Different possibilities of empirical treatment are suggested. After failure of proton pump inhibitor (PPI)-amoxicillin-clarithromycin, quadruple therapy has been generally used. More recently, replacing the PPI and the bismuth compound by ranitidine bismuth citrate has also achieved good results. After PPI-amoxicillin-nitroimidazole failure, retreatment with PPI-amoxicillin-clarithromycin has proved to be effective. Finally, the first therapy should not combine clarithromycin and metronidazole in the same regimen because of the problem of resistance against both antibiotics. Recently, rifabutin-based rescue therapies have been shown to constitute an encouraging strategy for eradication failures because they are effective for H. pylori strains resistant to antibiotics.

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“…Ranitidine bismuth citrate is believed to be more potent in the treatment of gastrointestinal disorders since it combines the activity of ranitidine, which reduces the excretion of gastric acid and bismuth citrate, which protects the mucous membrane of the stomach and inhibits H. pylori colonization. Furthermore, the combination of RBC with antibodies can provide a higher efficacy in healing stomach ulcers [21]. A new complex of bismuth with d-polygalacturonic acid, the so called 'colloidal bismuth pectin', approved in clinical use in China, shows the similar effectiveness to CBS in the treatment of H. pylori positive duodenal ulcer in triple and quadruple therapies [22].…”

Section: Bismuth In Medicinementioning

confidence: 99%