Efficacy of Non-Bismuth Quadruple “Concomitant” Therapy for H. pylori Infection in a Setting With High Clarithromycin Resistance

Molina–Infante, Javier; Pazos-Pacheco, Maria del Carmen; Gallardo, Belen Perez; Rodriguez, Gema Vinagre; Alonso, Moises Hernandez; Dueñas, Carmen; González-García, Guadalupe; Rodriguez, Jose M. Mateos; Bermejo, Miguel Fernández; Gisbert, Javier P.

doi:10.1016/s0016-5085(11)63658-5

Cited by 3 publications

(7 citation statements)

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“…Indirect evidence supporting an advantage of a concomitant regimen over a sequential regimen comes from a recent study 50. The authors evaluated the efficacy of empiric concomitant therapy in a geographical area (Spain) where sequential therapy had previously proved inefficient (76% cure rate in a prior study24).…”

Section: Effects Of Different Variables On the Efficacy Of Concomitanmentioning

confidence: 99%

“…The authors evaluated the efficacy of empiric concomitant therapy in a geographical area (Spain) where sequential therapy had previously proved inefficient (76% cure rate in a prior study24). Eradication rates for the concomitant regimen were 88% by per-protocol analysis and 85% by intention-to-treat analysis, and the authors concluded that in settings with high clarithromycin resistance (>5%–20%) and documented failure of sequential therapy, concomitant therapy may achieve acceptable eradication rates 50. The reason for this theoretical advantage of concomitant therapy over sequential therapy (which should be confirmed in randomized controlled trials including both regimens in the same study) may be a lower effect of antibiotic resistance on the eradication rate with concomitant therapy (when all three antibiotics are administered concurrently) or the longer period of time each antibiotic is prescribed (5 days in the sequential regimen and 7–10 days in the 7 to 10-day concomitant regimen).…”

Section: Effects Of Different Variables On the Efficacy Of Concomitanmentioning

confidence: 99%

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Update on non-bismuth quadruple (concomitant) therapy for eradication of Helicobacter pylori

Gisbert¹,

Calvet²

2012

CEG

120

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BackgroundTraditional standard triple therapy for Helicobacter pylori (H. pylori) infection (proton pump inhibitor-clarithromycin-amoxicillin) can easily be converted to non-bismuth quadruple (concomitant) therapy by the addition of a nitroimidazole twice daily.AimTo critically review evidence on the role of non-bismuth quadruple therapy (proton pump inhibitor-clarithromycin-amoxicillin-nitroimidazole) in the treatment of H. pylori infection.MethodsBibliographical searches were performed in MEDLINE and relevant congresses up to December 2011. We performed a meta-analysis of the studies evaluating the concomitant therapy, and of the randomized controlled trials comparing the concomitant and the standard triple therapy.ResultsA meta-analysis of 19 studies (2070 patients) revealed a mean H. pylori cure rate (intention-to-treat) of 88% (95% confidence interval from 85% to 91%) for non-bismuth quadruple therapy. We performed a meta-analysis of the randomized controlled studies comparing the concomitant (481 patients) and the standard triple therapy (503 patients). The former was more effective than the latter: 90% versus 78% (intention-to-treat analysis). Results were homogeneous (I2 = 0%). The odds ratio for this comparison was 2.36 (95% confidence interval from 1.67 to 3.34). A tendency toward better results with longer treatments (7–10 days versus 3–5 days) has been observed, so it seems reasonable to recommend the length of treatment achieving the highest cure rates (10 days). Clarithromycin resistance may reduce the efficacy of non-bismuth quadruple therapy, although the decrease in eradication rates seems to be far lower than in standard triple therapy. Experience with the non-bismuth quadruple therapy in patients with metronidazole-resistant strains is still very limited.ConclusionNon-bismuth quadruple (concomitant) therapy appears to be an effective, safe, and well-tolerated alternative to triple therapy and is less complex than sequential therapy. Therefore, this regimen appears well suited for use in settings where the efficacy of triple therapy is unacceptably low.

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Section: Effects Of Different Variables On the Efficacy Of Concomitanmentioning

confidence: 99%

Section: Effects Of Different Variables On the Efficacy Of Concomitanmentioning

confidence: 99%

Update on non-bismuth quadruple (concomitant) therapy for eradication of Helicobacter pylori

Gisbert¹,

Calvet²

2012

CEG

120

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“…Studies evaluating the efficacy of the concomitant regimen are summarised in Table 1 and are represented graphically in Figure 1. 31, 32, 45–57 These studies were performed in different countries in Europe, Asia, and Latin America and most were randomised controlled trials. Similar concomitant regimens were prescribed, with only minor modifications, namely, the PPI (omeprazole, lansoprazole, rabeprazole, or esomeprazole) and the nitroimidazole (metronidazole or tinidazole).…”

Section: Efficacy Of the Concomitant Regimen For Eradication Of H Pymentioning

confidence: 99%

“…Indirect evidence supporting an advantage of a concomitant regimen over a sequential regimen comes from the recent study by Molina‐Infante et al. 48 The authors evaluated the efficacy of empiric concomitant therapy in a geographical area (in Spain) where sequential therapy had previously proved inefficient (76% cure rate in a prior study 23 ). Eradication rates for the concomitant regimen were 88% by per‐protocol analysis and 86% by intention‐to‐treat analysis, and the authors concluded that in settings with high clarithromycin resistance (>15–20%) and documented failure of sequential therapy, concomitant therapy may achieve acceptable eradication rates 48 .…”

Section: Effects Of Different Variables On the Efficacy Of Concomitanmentioning

confidence: 99%

“… 48 The authors evaluated the efficacy of empiric concomitant therapy in a geographical area (in Spain) where sequential therapy had previously proved inefficient (76% cure rate in a prior study 23 ). Eradication rates for the concomitant regimen were 88% by per‐protocol analysis and 86% by intention‐to‐treat analysis, and the authors concluded that in settings with high clarithromycin resistance (>15–20%) and documented failure of sequential therapy, concomitant therapy may achieve acceptable eradication rates 48 . The reason for this theoretical advantage of concomitant therapy over sequential therapy (which should be confirmed in randomised controlled trials including both regimens in the same study) may be a lower effect of antibiotic resistance on the eradication rate with concomitant therapy (when all the three antibiotics are administered concurrently) or the longer period of time each antibiotic is prescribed (5 days in the sequential regimen and 7–10 days in the 7‐ to 10‐day concomitant regimen).…”

Section: Effects Of Different Variables On the Efficacy Of Concomitanmentioning

confidence: 99%

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Review article: non-bismuth quadruple (concomitant) therapy for eradication of Helicobater pylori

Gisbert

2011

Alimentary Pharmacology &Amp; Therapeutics

146

104

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Aliment Pharmacol Ther 2011; 34: 604–617 Summary Background Traditional standard triple therapy for Helicobacter pylori infection (PPI‐clarithromycin‐amoxicillin) can easily be converted to non‐bismuth quadruple (concomitant) therapy by the addition of a nitroimidazole twice daily. Aim To critically review evidence on the role of non‐bismuth quadruple therapy (PPI‐clarithromycin‐amoxicillin‐nitroimidazole) in the treatment of H. pylori infection. Methods Bibliographical searches were performed in MEDLINE and relevant congresses. Results The first randomised comparison of the non‐bismuth quadruple therapy and the sequential (PPI‐amoxicillin 5 days plus PPI‐clarithromycin‐nitroimidazole 5 days) regimens recently concluded that both were similar in terms of efficacy and safety and that the sequential administration protocol may be unnecessarily complex. Several randomised controlled trials (and one meta‐analysis) have demonstrated that non‐bismuth quadruple therapy is more effective than and is equally well tolerated as standard triple therapy. A meta‐analysis of 15 studies (1723 patients) revealed a mean H. pylori cure rate (intention‐to‐treat) of 90% for non‐bismuth quadruple therapy. A tendency towards better results with longer treatments (7–10 days vs. 3–5 days) has been observed, so it seems reasonable to recommend the length of treatment by achieving maximal cure rates (10 days). Clarithromycin resistance may reduce the efficacy of non‐bismuth quadruple therapy, although the decrease in eradication rates seems to be far lower than in standard triple therapy. Experience with the non‐bismuth quadruple therapy in patients with metronidazole‐resistant strains is still very limited. Conclusions Non‐bismuth quadruple (concomitant) therapy appears to be an effective, safe, and well‐tolerated alternative to triple therapy and is less complex than sequential therapy. Therefore, this regimen appears well suited for use in settings where the efficacy of triple therapy is unacceptably low.

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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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Efficacy of Non-Bismuth Quadruple “Concomitant” Therapy for H. pylori Infection in a Setting With High Clarithromycin Resistance

Cited by 3 publications

References 0 publications

Update on non-bismuth quadruple (concomitant) therapy for eradication of Helicobacter pylori

Update on non-bismuth quadruple (concomitant) therapy for eradication of Helicobacter pylori

Review article: non-bismuth quadruple (concomitant) therapy for eradication of Helicobater pylori

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

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