Greater Than 95% Success with 14‐day <scp>B</scp>ismuth Quadruple Anti‐<i><scp>H</scp>elicobacter pylori</i> Therapy: A Pilot Study in <scp>US H</scp>ispanics

Salazar, Cesar O.; Cárdenas, Víctor; Reddy, Ram; Domı́nguez, Delfina C.; Snyder, Lindsey K.; Graham, David Y.

doi:10.1111/j.1523-5378.2012.00962.x

Cited by 49 publications

(46 citation statements)

References 44 publications

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“…The most common for early stopping was the presence of an adverse event. As would be expected, treatment success increased as the duration of therapy increased (Table 1, Figure 5) 43 . The cure rate ITT was 70% and PP was >95%.…”

Section: Adherence (Compliance) With Bismuth Quadruple Therapysupporting

confidence: 66%

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How to Effectively Use Bismuth Quadruple Therapy

Graham

Lee

2015

Gastroenterology Clinics of North America

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133

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Bismuth triple therapy was the first truly effective Helicobacter pylori eradication therapy. The addition of a proton pump inhibitor largely overcame the problem of metronidazole resistance. Resistance to its being the primary first line therapy have centered on convenience (the large number of tablets required) and side effects causing difficulties with patient adherence. Understanding why the regimen is less successful in some regions remains unexplained in part because of the lack of studies including susceptibility testing. A number of modifications have been proposed such as twice-a-day therapy which addresses both major criticism but the studies with susceptibility testing required to prove its effectiveness in high metronidazole resistance areas are lacking. Most publications lack the data required to understand why they were successful or failed (e.g., detailed resistance and adherence data) and are therefore of little value. We discuss and provide recommendations regarding variations including substitution of doxycycline, amoxicillin, and twice a day therapy. We describe what is known and unknown and provide suggestions regarding what is needed to rationally and effectively use bismuth quadruple therapy. Its primary use is when penicillin cannot be used or when clarithromycin and metronidazole resistance is common. Durations of therapy less than 14 days are not recommended.

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Section: Adherence (Compliance) With Bismuth Quadruple Therapysupporting

confidence: 66%

“…An example is a 14 day treatment trial using a formulation in which the antibiotics and bismuth are contained within the same capsules (i.e., Pylera) and omeprazole 20 mg b.i.d. 43 . Forty-seven subjects were entered and 12 (25.5%) failed to take the planned 14 days of therapy.…”

Section: Adherence (Compliance) With Bismuth Quadruple Therapymentioning

confidence: 99%

How to Effectively Use Bismuth Quadruple Therapy

Graham

Lee

2015

Gastroenterology Clinics of North America

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133

174

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“…Possibly, the most effective BQT is the one employing the highest practical doses of the single drugs for the longest reasonable duration, such as 14 days. A one-arm, open-label pilot study of 47 H. pylori -infected, asymptomatic/mildly dyspeptic adult Hispanic residents of El Paso, Texas showed a per-protocol effectiveness of 97.7% for BQT given for 14 days [34]. In this study the combination capsule of bismuth, metronidazole, and tetracycline (daily doses: 1,680, 1,500, and 1,500 mg, respectively) plus omeprazole (daily dose: 40 mg) was used.…”

Section: Discussionmentioning

confidence: 99%

Meta-Analysis of Bismuth Quadruple Therapy versus Clarithromycin Triple Therapy for Empiric Primary Treatment of Helicobacter pylori Infection

Venerito

Krieger²,

Ecker³

et al. 2013

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149

114

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Background: In areas with high clarithromycin resistance, bismuth quadruple therapy (BQT) is recommended instead of clarithromycin triple therapy (CTT) as the first-line treatment for Helicobacter pylori eradication. Methods: Randomized clinical trials (RCTs) comparing BQT to CTT were identified through electronic and manual searches. A meta-analysis was performed to compare the efficacy and tolerability of these two regimens as first-line treatments for H. pylori infection. The effect of antibiotic resistance on treatment efficacy was also analyzed. Results: Twelve RCTs were included. BQT achieved eradication in 77.6% of patients, whereas CTT achieved an eradication rate of 68.9% [risk difference (RD) = 0.06, 95% CI: -0.01/0.13]. A high heterogeneity among the trials was found (χ² = 50.16, p < 0.00001; I² = 78%). In the subgroup analysis for treatment duration, the 10-day BQT was more effective than the 7-day CTT (RD = 0.25, 95% CI: 0.18/0.32), whereas no differences were observed between CTT and BQT given for 7 or 10 days. There were no statistical differences in side effects and compliance between both therapies (RD = 0.92, 95% CI: 0.76/1.12, and RD = -0.03, 95% CI: -0.05/0.00, respectively). The effect of antibiotic resistance on eradication rates was reported in 4 of the 12 RCTs. Clarithromycin resistance significantly affected the efficacy of CTT (RD = 0.75, 95% CI: 0.63/0.87), whereas BQT efficacy was not affected by metronidazole resistance (RD = 0.09, 95% CI: -0.06/0.25). Conclusions: The 10-day BQT was more effective than the 7-day CTT as a first-line therapy for H. pylori infection, whereas BQT and CTT for 7 or 10 days yielded similar eradication rates. Compliance and side effect rates were similar for both therapies. BQT overcomes clarithromycin resistance and its efficacy is not affected by metronidazole resistance.

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“…For example, the ITT eradication rate with modified bismuth quadruple therapy was 92.7% in a recent randomized study in Chinese patients [79] . A pilot study in United States Hispanics showed that 14-d bismuth quadruple anti-H. pylori therapy achieved a > 95% eradication rate [80] . However, in some studies the eradication rate of bismuth quadruple therapy was < 80% [81][82][83] .…”

Section: Publication Treatment Duration Patients Therapy Regimen Eradmentioning

confidence: 99%

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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Greater Than 95% Success with 14‐day Bismuth Quadruple Anti‐Helicobacter pylori Therapy: A Pilot Study in US Hispanics

Cited by 49 publications

References 44 publications

How to Effectively Use Bismuth Quadruple Therapy

How to Effectively Use Bismuth Quadruple Therapy

Meta-Analysis of Bismuth Quadruple Therapy versus Clarithromycin Triple Therapy for Empiric Primary Treatment of Helicobacter pylori Infection

Antibiotic treatment forHelicobacter pylori: Is the end coming?

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