Empirical or susceptibility-guided treatment for<i>Helicobacter pylori</i>infection? A comprehensive review

Gisbert, Javier P.

doi:10.1177/1756284820968736

Cited by 69 publications

(79 citation statements)

References 121 publications

(224 reference statements)

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“…Furthermore, H. pylori has slow bacterial growth and particular nutritional requirements, and culture-based methods are time-consuming (10 to 15 days), expensive, technically challenging, susceptible to inter-observer variability, and are not able to detect hetero-resistance status [ 11 ]. For these reasons, even tailored regimens were found to be no better than empiric therapies [ 51 ]. Therefore, standard therapies are empirically administered for H. pylori infection retreatment in clinical practice.…”

Section: Discussionmentioning

confidence: 99%

Rescue Therapies for H. pylori Infection in Italy

et al. 2021

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Background/Aims: Curing Helicobacter pylori infection remains challenging for clinicians, as no proposed first-line therapy achieves bacterial eradication in all treated patients so that several patients need two or more consecutive treatments. Bacterial culture with antibiotics susceptibility testing is largely unachievable in Italy, and empiric second-line and rescue therapies are generally used. This study aimed to identify what eradication regimens perform better in Italy, following first-line therapy failure. Methods: We performed a literature search on PubMed for studies on standard therapy regimens used as second-line or rescue treatments performed in adult patients. Studies including modified drug combinations were not considered. Both intention-to-treat and per- protocol analyses were computed for each therapy subgroup. Results: Data from 35 studies with a total of 4830 patients were eventually considered. As a second-line therapy, Pylera® (90.6%) and a sequential regimen (89.8%) achieved eradication rates significantly higher than other therapies. For third-line therapy, a levofloxacin-based regimen and Pylera® achieved comparable eradication rates (88.2% vs. 84.7%; p = 0.2). Among therapies used as fourth (or more) attempts, Pylera® and a rifabutin-based therapy achieved 77.4% and 66.4% cure rates, respectively (p = 0.013). A therapy sequence based on the type of first-line therapy used was proposed. Conclusions: Data obtained through our review indicate that standard therapies for H. pylori eradication can be used when following an appropriate sequence, allowing clinicians to improve the cure rate without resorting to bacterial culture.

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Section: Discussionmentioning

confidence: 99%

Rescue Therapies for H. pylori Infection in Italy

et al. 2021

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“…Consequently, in some cases, H. pylori infection persists even after two or more eradication treatments, and these patients constitute a therapeutic dilemma. Currently, a standard third/fourth-line therapy is lacking, and international guidelines recommend performing culture in these patients to select a rescue treatment according to microbial sensitivity to antibiotics, but this strategy is not practical [ 14 ]. Therefore, the evaluation of drugs without cross-resistance to macrolides, nitroimidazole or quinolones as components of retreatment combination therapies seems to be worthwhile [ 15 , 16 ].…”

Section: Introductionmentioning

confidence: 99%

Rifabutin for the Treatment of Helicobacter pylori Infection: A Review

Gisbert¹

2020

Pathogens

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Nowadays, apart from having to know first-line Helicobacter pylori eradication regimens well, we must also be prepared to face treatment failures. The aim of this review is to summarize the role of rifabutin in the management of H. pylori infection. Bibliographical searches were performed in PubMed. Data on resistance and efficacy of rifabutin-containing regimens on H. pylori eradication were meta-analyzed. Mean H. pylori rifabutin resistance rate (39 studies, including 9721 patients) was 0.13%; when studies only including patients naïve to H. pylori eradication treatment were considered, this figure was even lower (0.07%). Mean H. pylori eradication rate (by intention-to-treat) with rifabutin-containing regimens (3052 patients) was 73%. Respective cure rates for second-, third-, fourth- and fifth-line therapies, were 79%, 69%, 69% and 72%. Most studies administered rifabutin 300 mg/day, which seemed to be more effective than 150 mg/day. The ideal length of treatment remains unclear, but 10–12-day regimens are generally recommended. Adverse events to rifabutin treatment in H. pylori studies were relatively infrequent (15%), and severe adverse events were exceptional (myelotoxicity was the most significant, although always reversible). In summary, rifabutin-containing therapy represents an encouraging strategy generally restricted, at present, to patients where previous (usually multiple) eradication regimens have failed.

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“…Gweon et al showed that the cost for a successful eradication using DPObased PCR would be similar or superior to the expected cost of a successful eradication with a 14-day empirical treatment when the first-line eradication rate is ≤80% [29]. Since H. pylori antibiotic resistance varies among different geographic areas, the cost-effectiveness may vary according to the cost of care in a given country, and therefore the same conclusion may not be applicable to other healthcare systems [30].…”

Section: Discussionmentioning

confidence: 99%

Cost-Effectiveness, Efficacy, and Safety Analysis of Tailored Therapy in Patients with Helicobacter pylori Infection

Choe

Shim

Park

et al. 2021

JCM

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Recently in Korea, where triple therapy is accepted as the first-line Helicobacter pylori (H. pylori) eradication treatment, antibiotic resistance to clarithromycin has increased considerably, resulting in eradication rates of less than 80%. We investigated the efficacy of tailored therapy after a clarithromycin resistance test compared with empirical therapy for H. pylori eradication. The cost-effectiveness of H. pylori eradication success was evaluated according to the average medical cost per patient. A total of 364 patients were enrolled in the study. The first-line H. pylori eradication rate was significantly higher in patients who received tailored therapy than in those who received empirical therapy. The total medical costs for the tailored and empirical groups were 46,374 Won and 53,528 Won. The total treatment period for each ultimately successful eradication in the tailored group was 79.8 ± 2.8 days, which is shorter than that of the empirical group (99.2 ± 7.4 days). The rate of eradication-related adverse events for the tailored group and empirical group was 12.9% and 14.8%, respectively. Tailored therapy could be a useful option to achieve a higher successful eradication rate, shorter treatment periods, and lower medical costs than empirical therapy in the era of increasing antibiotic resistance.

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Empirical or susceptibility-guided treatment forHelicobacter pyloriinfection? A comprehensive review

Cited by 69 publications

References 121 publications

Rescue Therapies for H. pylori Infection in Italy

Rescue Therapies for H. pylori Infection in Italy

Rifabutin for the Treatment of Helicobacter pylori Infection: A Review

Cost-Effectiveness, Efficacy, and Safety Analysis of Tailored Therapy in Patients with Helicobacter pylori Infection

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