Efficacy of Tailored <i>Helicobacter pylori</i> Eradication Treatment Based on Clarithromycin Susceptibility and Maintenance of Acid Secretion

Sugimoto, Mitsushige; Uotani, Takahiro; Sahara, Shu; Ichikawa, Hitomi; Yamade, Mihoko; Sugimoto, Ken; Furuta, Takahisa

doi:10.1111/hel.12128

Cited by 50 publications

(34 citation statements)

References 45 publications

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“…MNZ based conventional triple therapy has sufficiently high eradication success rate in Japan[3-7]. It has been reported that sufficient acid inhibition during eradication was more important in CAM based regimen than MNZ[15]. Therefore, we could not show the difference in secondary eradication therapy between the PPI group and the vonoprazan group.…”

Section: Discussionmentioning

confidence: 84%

Usefulness of vonoprazan, a potassium ion-competitive acid blocker, for primary eradication ofHelicobacter pylori

Yamada¹,

Kawakami²,

Nakatsugawa³

et al. 2016

WJGPT

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AIMTo investigate usefulness of triple therapy with vonoprazan, a potassium ion-competitive acid blocker and antibiotics, for Helicobacter pylori (H. pylori) eradication.METHODSThe H. pylori eradication rate was examined in 2507 patients (2055 undergoing primary eradication and 452 undergoing secondary eradication, excluding patients with subtotal gastrectomy) at the Japanese Red Cross Kyoto Daiichi Hospital from March 2013 to September 2015. For patients treated from March 2013 to February 2015, a proton pump inhibitor (PPI) was used to reduce acid secretion, while vonoprazan was used after March 2015. The success rates of the 2 regimens (PPI + amoxicillin + clarithromycin/metronidazole, or vonoprazan + amoxicillin + clarithromycin/metronidazole) were compared.RESULTSThe success rate of primary H. pylori eradication was significantly higher in the vonoprazan group. When stratified by the underlying disease, a significant increase of the H. pylori eradication rate was observed in patients with chronic gastritis. A significantly lower H. pylori eradication rate was observed in younger patients compared to older patients in the PPI group, but there was no difference according to age in the vonoprazan group. On the other hand, the success rate of secondary eradication was similar at approximately 90% in both groups.CONCLUSIONVonoprazan is very useful for primary eradication of H. pylori, and may become a first-line acid secretion inhibitor instead of PPIs.

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Section: Discussionmentioning

confidence: 84%

Usefulness of vonoprazan, a potassium ion-competitive acid blocker, for primary eradication ofHelicobacter pylori

Yamada¹,

Kawakami²,

Nakatsugawa³

et al. 2016

WJGPT

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“…In a tailored regimen, H. pylori patients with clarithromycinsensitivity were treated with clarithromycin, amoxicillin, rabeprazole, while clarithromycin-resistant patients were treated with metronidazole, amoxicillin, rabeprazole for 1 wk. As a result, the overall eradication rate was 96.7% (95%CI: 92.5%-98.9%) by ITT analysis and 97.4% (95%CI: 93.4%-99.3%) by PP analysis [148] . The method achieved high eradication rates of 94.3% in CYP2C19 rapid metabolizers [148] .…”

Section: Publication Treatment Duration Patients Therapy Regimen Eradmentioning

confidence: 96%

“…As a result, the overall eradication rate was 96.7% (95%CI: 92.5%-98.9%) by ITT analysis and 97.4% (95%CI: 93.4%-99.3%) by PP analysis [148] . The method achieved high eradication rates of 94.3% in CYP2C19 rapid metabolizers [148] . Although CYP2C19 genotyping remains difficult clinically, tailored therapy may be useful in overcoming decreased eradication rates.…”

Section: Publication Treatment Duration Patients Therapy Regimen Eradmentioning

confidence: 96%

“…In studies published in Japan, esomeprazole and rabeprazole are less influenced by CYP2C19 genotype compared with another PPIs [146,147] . The efficacy of tailored H. pylori eradication treatment was demonstrated by Sugimoto et al [148] . In a tailored regimen, H. pylori patients with clarithromycinsensitivity were treated with clarithromycin, amoxicillin, rabeprazole, while clarithromycin-resistant patients were treated with metronidazole, amoxicillin, rabeprazole for 1 wk.…”

Section: Publication Treatment Duration Patients Therapy Regimen Eradmentioning

confidence: 97%

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Antibiotic treatment forHelicobacter pylori: Is the end coming?

Kim

Choi

Chung

2015

WJGPT

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Infection with the Gram-negative pathogen Helicobacter pylori (H. pylori ) has been associated with gastroduodenal disease and the importance of H. pylori eradication is underscored by its designation as a group I carcinogen. The standard triple therapy consists of a proton pump inhibitor, amoxicillin and clarithromycin, although many other regimens are used, including quadruple, sequential and concomitant therapy regimens supplemented with metronidazole, clarithromycin and levofloxacin. Despite these efforts, current therapeutic regimens lack efficacy in eradication due to antibiotic resistance, drug compliance and antibiotic degradation by the acidic stomach environment. Core tip: This article reviews the recent literature describing antibiotic resistance and trends in Helicobacter pylori (H. pylori ) treatment. As there is no effective conventional therapy, new treatments are being developed and bismuth quadruple, sequential, concomitant therapies are recommended as a first-line regimen in regions with high levels of clarithromycin resistance. Quinolones have also been used for H. pylori treatment, although the cure rate has gradually reduced with this approach. New therapeutic directions include probiotic supplementation, tailored therapy, novel agents, and nanotechnology.

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“…In Japan, as the first-line H. pylori eradication therapy, a triple regimen consisting amoxicillin, clarithromycin, and a proton pump inhibitor (PPI) or vonoprazan is used, whereas the incidence rate of clarithromycin-resistance H. pylori strain is higher than 35% [17, 18]. However, because the maximum blood concentration and half-life time (t 1/2 ) of amoxicillin significantly differ between hemodialysis patients and non-dialysis patients [19], the efficacy and safety of conventional eradication regimens for hemodialysis patients have not yet been established.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of Reduced Dosage of Amoxicillin in an Eradication Therapy for Helicobacter pylori Infection in Patients on Hemodialysis: A Randomized Controlled Trial

et al. 2018

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Background: An optimum Helicobacter pylori-eradication regimen for hemodialysis patients is yet to be established because of different pharmacokinetics of amoxicillin involved between hemodialysis patients and healthy subjects. We investigated to establish appropriate doses of amoxicillin for H. pylori infection eradication in hemodialysis patients. Methods: Of 409 hemodialysis patients screened for H. pylori infection, 37 H. pylori-positive patients were randomized to different 1-week eradication regimens: esomeprazole 20 mg twice a day (b.i.d.) and clarithromycin 200 mg b.i.d., plus amoxicillin at either 750 mg b.i.d. (group A; conventional) or 250 mg b.i.d. (group B; experimental). Sixty-three patients with normal renal function received the conventional regimen (group C). Successful eradication was confirmed by urea breath testing. Results: Eradication rates of group B (reduced amoxicillin-regimen) were 84.2% in intention-to-treat analysis and 88.9% in per-protocol analysis, which were similar with group A (77.8 and 77.8%) and group C (74.6 and 81.0%). However, the incidence of adverse events in group A was significantly higher than that in group C (22.2 vs. 5.1%, p = 0.027). Conclusions: In H. pylori-positive hemodialysis patients, amoxicillin at 250 mg b.i.d. may be an appropriate scheme for eradication with equivalent effects to the conventional therapy and safety effects for adverse events.

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Efficacy of Tailored Helicobacter pylori Eradication Treatment Based on Clarithromycin Susceptibility and Maintenance of Acid Secretion

Abstract: A tailored H. pylori eradication regimen based on CAM susceptibility and maintaining acid secretion (rabeprazole 10 mg q.i.d.) is useful because it can achieve an eradication rate exceeding 95%, irrespective of eradication history, thus overcoming differences among CYP2C19 genotypes.

Cited by 50 publications

References 45 publications

Usefulness of vonoprazan, a potassium ion-competitive acid blocker, for primary eradication ofHelicobacter pylori

Usefulness of vonoprazan, a potassium ion-competitive acid blocker, for primary eradication ofHelicobacter pylori

Antibiotic treatment forHelicobacter pylori: Is the end coming?

Efficacy of Reduced Dosage of Amoxicillin in an Eradication Therapy for Helicobacter pylori Infection in Patients on Hemodialysis: A Randomized Controlled Trial

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