Helicobacter pylori eradication following first-line treatment failure in Europe: What, how and when chose among different standard regimens? A systematic review

Abstract

Cure rate following standard first-line regimens for Helicobacter pylori eradication is decreasing so several patients require two or more treatments. Antibiotic susceptibility-based therapy, advised in current guidelines, is largely impracticable in clinical practice. Some 'standard' regimens (triple therapies based on either levofloxacin or rifabutin, bismuth-based quadruple therapies, sequential, concomitant and hybrid therapies) were empirically used as rescue therapies. We performed a systematic review on recent studies carried out in European countries dealing with these regimens. A total of 24 studies, with 3804 patients, were identified. As second-line therapy, Pylera (89.2%) and sequential therapy (92.5%) achieved significantly higher cure rates as compared to all the other regimens. As third-line therapy, levofloxacin-based therapy (84.1%) and Pylera (83.6%) achieved similarly high cure rates, whereas standard, bismuth-based quadruple therapy (64.1%) achieved the lowest. As a rescue therapy, the success rate was close to 75% following all therapies used, with data on rifabutin-based regimen consolidated in the larger sample size. Overall, levofloxacin-amoxicillin triple therapy achieved higher eradication rates when the 14-rather than 10-day regimen was used (87.1 vs. 72.2%; P = 0.003). Among bismuth-based therapies, Pylera achieved a significantly higher eradication rate than standard quadruple therapy (88 vs. 67%; P < 0.0001). These data suggest that a wise 'therapeutic package' following first-line therapy could be Pylera, levofloxacin-and rifabutin-based therapy, as long as Pylera therapy was not used as a first-line regimen and levofloxacin-based regimen was administered for 14 days. Eur J Gastroenterol Hepatol 33: e66-e70

Rescue Therapies for H. pylori Infection in Italy

“…On the other hand, a tailored sequence has been reported for these patients [53]. Of note, data from a systematic review, including recent studies on rescue therapy for H. pylori infection performed in European countries, found similar results [54]. Therefore, the therapeutic sequence we proposed could also be applied in other geographic areas.…”

“…Unexpectedly, no data were available on concomitant, hybrid and high-dose dual therapy. Interest in the last regimen was recently renewed, even as a first-line therapy [ 54 ]. Data of 3 meta-analyses found that dual therapy with high-dose PPI and amoxicillin achieved similar eradication rates to levofloxacin-based, rifabutin-based and bismuth-based quadruple therapies when used as rescue therapy, but with a significantly lower side-effect rate [ 55 , 56 , 57 ].…”

Culture-based antibiotic susceptibility testing for Helicobacter pylori infection: a systematic review

“…Notably, data from a recent systematic review showed that by adopting an empiric therapeutic sequence with bismuth-based quadruple therapy, levofloxacin- and rifabutin-based regimens following first-line therapy failure, H. pylori infection might be cured in virtually all patients, with only 1 in every 170 patients eventually remaining infected [ 67 ]. Therefore, the real advantage of resorting to bacterial susceptibility testing before third-line therapy, as suggested in the current guidelines [ 7 , 8 ], probably needs to be corroborated by further data.…”

TCM-Based Therapy as a Rescue Therapy for Re-Eradication of Helicobacter pylori Infection: A Systematic Review and Meta-Analysis

“…The included studies were selected based on PICOS (population, intervention, comparators, outcomes, and study design) eligibility criteria. The inclusion standards were as follows: (a) subjects with Hp-positive and without region, sex, and age restrictions; (b) both control group (defined as patients treated with only Western medicine) and experimental group (defined as patients treated with TCM combined with Western medicine) have received the first-line therapy regimens [ 8 ] recommended in the current Consensus Report and failed to eradicate Hp; (c) TCM treatments in the experimental group include single herb, formulas, or herbal products in any formulations such as oral decoction, pill, powder, or granules; (d) randomized controlled and parallel trials were performed, regardless of whether blinding was adopted, and had a duration of at least one week; and (e) the trial included outcome indicators with Hp eradication rates at least. The definition of the Hp eradication rates must conform to the requirements of the current Consensus Report.…”

“…However, the eradication rate decreased year by year due to bacterial factors, patient compliance, and reinfection; among which, antibiotic resistance is the most important factor [ 7 ] and resistance to clarithromycin is particularly serious. For patients who were treated with triple therapy yet failed, a bismuth quadruple therapy (such as metronidazole, tetracycline, bismuth, and a PPI) is recommended [ 8 ]. Nevertheless, the resistance rate of metronidazole and tetracycline has also exceeded 15% globally [ 9 ].…”