Empiric therapies for <i>Helicobacter pylori</i> infections: Figure 1:

Graham, David Y.; Fischbach, Lori

doi:10.1503/cmaj.101460

Cited by 18 publications

(13 citation statements)

References 14 publications

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“…The e cacy of H. pylori eradication in our study population using a standard triple therapy regimen was 89.7%, in contrast to data showing a trend for declining cure rates (≤ 80%) with triple therapy over the past two decades [47][48][49] . Current guidelines recommend the choice of therapy based on regional rates of antibiotic resistance 7 .…”

Section: Discussioncontrasting

confidence: 82%

Population-Based Screening and Eradication of Helicobacter pylori in a Resource-Limited Population of Sub-Saharan Africa

Lee

Ssekalo²,

Kazungu³

et al. 2020

Preprint

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Background: Helicobacter pylori (H. pylori) infection is a common cause of chronic dyspepsia worldwide. Its prevalence in the developing world remains understudied, however. Given that H. pylori is the most significant risk factor for developing gastric cancer, an accurate assessment of the effectiveness of population-based screening and eradication of H. pylori is warranted. The objectives of this study were to determine the prevalence of H. pylori, to identify risk factors associated with H. pylori colonization, and to assess the efficacy of triple therapy on H. pylori eradication within a region of sub-Saharan Africa.Methods: We administered a dyspepsia questionnaire to 376 randomly selected adult residents of the Namutumba District in Uganda. Participants submitted a stool sample for H. pylori fecal antigen testing. H. pylori-positive participants were given standard triple therapy. The efficacy of triple therapy on H. pylori eradication was established by fecal H. pylori antigen testing and improvement in dyspepsia scores after treatment. Dyspeptic, H. pylori-negative participants were administered daily omeprazole for one month. Logistic regression analyses were used to identify factors associated with H. pylori positivity, chronic dyspepsia, and H. pylori eradication failure.Results: The prevalence of H. pylori within the study population was 48%. A higher level of education was significantly associated with H. pylori positivity. 87% of study participants reported at least one symptom of dyspepsia, with 43% reporting moderate or severe dyspepsia. Dyspepsia severity was independent of H. pylori status. Standard triple therapy resulted in ~90% eradication. Missing four or more doses of the triple therapy regimen was significantly associated with H. pylori eradication failure.Conclusions: Chronic dyspepsia is a common complaint in this sub-Saharan population but is not by itself a defining feature of H. pylori positivity. Clinical suspicion for H. pylori within this population should nonetheless remain high, given the high prevalence of positivity among all those with dyspepsia, including many with relatively mild dyspeptic symptoms. Population-based screening and adherence to standard triple therapy are effective at eradicating H. pylori within this region. Trial Registration: This study was registered in ClinicalTrials.gov (TRN: NCT04525664, registered 24 August 2020 – Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT04525664). This study adheres to CONSORT guidelines.

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Section: Discussioncontrasting

confidence: 82%

Population-Based Screening and Eradication of Helicobacter pylori in a Resource-Limited Population of Sub-Saharan Africa

Lee

Ssekalo²,

Kazungu³

et al. 2020

Preprint

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“…Tailored therapy based on pretreatment susceptibility testing is ideal for successful eradication; however, pretreatment susceptibility testing is difficult because of the limited availability of tests and their questionable cost‐effectiveness in the clinical setting. Therefore, physicians must make an empirical decision on therapy and, in this instance, the best approach is to use regimens that have been proven to be reliably excellent in the local area …”

Section: Discussionmentioning

confidence: 99%

Helicobacter pylori eradication rates of concomitant and sequential therapies in Korea

et al. 2017

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“…Pretreatment susceptibility testing, either by culture of the organism or indirectly by molecular testing of stools of infected patients or fluorescent in-situ hybridization (FISH) using parafin-embedded gastric biopsies, allows one to select regimen tailored by antimicrobial susceptibility (i.e., tailored therapy) 3 . However, in many instances, one must choose therapy empirically and in this instance, the best approach is to use regimens that have proven to be reliably excellent locally 2 . That choice should take advantage of knowledge of resistance patterns obtained from local or regional antimicrobial surveillance programs and/or based on local clinical experience with regard to which regimens are effective locally.…”

Section: Choice Of Therapymentioning

confidence: 99%

“…Treatment success depends on the details of the regimen including choice of drugs, doses, formulations, duration of therapy, administration in relation to meals, number of administrations/day, the use of adjuvants such as antisecretory drugs or mucolytics, etc 1 . Results can be defined in terms of treatment success 2, 3 . For exploratory studies the primary outcome is generally expressed per protocol (PP) which controls for compliance and other variables and thus provides an indication of the potential maximum success of regimen in clinical practice 1 .…”

Section: Introductionmentioning

confidence: 99%

Rational Helicobacter pylori Therapy: Evidence-Based Medicine Rather Than Medicine-Based Evidence

Graham

Lee

2014

Clinical Gastroenterology and Hepatology

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Data are available such that choice of Helicobacter pylori therapy for an individual patient can be reliably predicted. Here treatment success is defined at a cure rate of 90% or greater. Treatment outcome in a population or a patient can be calculated based on the effectiveness of a regimen for infections with susceptible and with resistant strains coupled with knowledge of the prevalence of resistance (i.e., based on formal measurement, clinical experience, or both). We provide the formula for predicting outcome and we illustrate the calculations. Because clarithromycin-containing triple therapy and 10 day sequential therapy are now only effective in special populations they are considered obsolete; neither should continue to be used as empiric therapies (i.e., 7 and 14 day triple therapies fail when clarithromycin resistance exceeds 5% and 15%, respectively and 10-day sequential therapy fails when metronidazole resistance exceeds 20%). Therapy should be individualized base on prior history and whether the patient is in a high risk group for resistance. The preferred choices for Western countries are 14 day concomitant therapy, 14 day bismuth quadruple therapy, and 14 day hybrid sequential-concomitant therapy. We also provide details regarding the successful use of fluoroquinolone-rifabutin-, and furazolidone-containing therapies. Finally, we give recommendations for efficient development (i.e., identification and optimization) of new regimens as well as how to prevent or minimized failures. The trial and error approach for identifying and testing regimens frequently resulted in poor treatment success. The approach described allows outcome to be predicted and should simplify treatment and drug development.

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Empiric therapies for Helicobacter pylori infections: Figure 1:

Cited by 18 publications

References 14 publications

Population-Based Screening and Eradication of Helicobacter pylori in a Resource-Limited Population of Sub-Saharan Africa

Population-Based Screening and Eradication of Helicobacter pylori in a Resource-Limited Population of Sub-Saharan Africa

Helicobacter pylori eradication rates of concomitant and sequential therapies in Korea

Rational Helicobacter pylori Therapy: Evidence-Based Medicine Rather Than Medicine-Based Evidence

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