<i>Helicobacter pylori</i>first‐line and rescue treatments in patients allergic to penicillin: Experience from the European Registry on<i>H pylori</i>management (Hp‐EuReg)

Nyssen, Olga P.; Pérez-Aísa, Ángeles; Tepeš, Bojan; Rodrigo-Sáez, Luis; Romero, Pilar Mata; Lucendo, Alfredo J.; Castro‐Fernández, Manuel; Phull, Perminder; Barrio, Jesús; Bujanda, Luís; Ortuño, Juan; Areia, Miguel; Jurecic, Natasa Brglez; Huguet, José María; Alcaide, Noelia; Voynovan, Irina; Bote, José María Botargues; Modolell, Inés; Lasala, Jorge Pérez; Ariño, I.; Jonaitis, Laimas Virginijus; Domínguez-Cajal, Manuel; Buzás, György Miklós; Lerang, Frode; Perona, Mónica; Bordin, D.S.; Axon, Toni; Gasbarrini, Antonio; Pinto, Ricardo Marcos; Niv, Yaron; Kupčinskas, Limas; Tonkić, Ante; Leja, Mārcis; Rokkas, Theodore; Boyanova, Lyudmila; Shvets, Oleg; Venerito, Marino; Bytzer, Peter; Goldiş, Adrian; Şımşek, İlkay; Lamy, V.; Przytulski, Krzysztof; Kunovský, Lumír; Capelle, Lisette; Milosavljević, Tomica; Caldas, María; Garre, Ana; Mégraud, Françis; O’Moráin, Colm; Gisbert, Javier P.

doi:10.1111/hel.12686

Cited by 27 publications

(48 citation statements)

References 36 publications

(69 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In our cohort, the effectiveness of clarithromycin-containing triple therapies with either metronidazole or levofloxacin was suboptimal in the allergic to penicillin population, in agreement with previously published evidence [33]. The use of the bismuth singlecapsule in this setting has markedly increased effectiveness, achieving up to 94% in our cohort in first-line treatment, thus confirming this regimen as the current therapy of choice in this population [1,9,34].…”

Section: Discussionsupporting

confidence: 89%

European Registry on Helicobacter pylori Management: Effectiveness of First and Second-Line Treatment in Spain

et al. 2020

Self Cite

View full text Add to dashboard Cite

The management of Helicobacter pylori infection has to rely on previous local effectiveness due to the geographical variability of antibiotic resistance. The aim of this study was to evaluate the effectiveness of first and second-line H. pylori treatment in Spain, where the empirical prescription is recommended. A multicentre prospective non-interventional registry of the clinical practice of European gastroenterologists concerning H. pylori infection (Hp-EuReg) was developed, including patients from 2013 until June 2019. Effectiveness was evaluated descriptively and through a multivariate analysis concerning age, gender, presence of ulcer, proton-pump inhibitor (PPI) dose, therapy duration and compliance. Overall, 53 Spanish hospitals were included, and 10,267 patients received a first-line therapy. The best results were obtained with the 10-day bismuth single-capsule therapy (95% cure rate by intention-to-treat) and with both the 14-day bismuth-clarithromycin quadruple (PPI-bismuth-clarithromycin-amoxicillin, 91%) and the 14-day non-bismuth quadruple concomitant (PPI-clarithromycin-amoxicillin-metronidazole, 92%) therapies. Second-line therapies were prescribed to 2448 patients, with most-effective therapies being the triple quinolone (PPI-amoxicillin-levofloxacin/moxifloxacin) and the bismuth-levofloxacin quadruple schemes (PPI-bismuth-levofloxacin-amoxicillin) prescribed for 14 days (92%, 89% and 90% effectiveness, respectively), and the bismuth single-capsule (10 days, 88.5%). Compliance, longer duration and higher acid inhibition were associated with higher effectiveness. “Optimized” H. pylori therapies achieve over 90% success in Spain.

show abstract

Section: Discussionsupporting

confidence: 89%

European Registry on Helicobacter pylori Management: Effectiveness of First and Second-Line Treatment in Spain

et al. 2020

Self Cite

View full text Add to dashboard Cite

show abstract

“…Since the incidence of primary resistance to CLR and LEV in H. pylori strains isolated in Poland has exceeded 15%, the conventional threshold of acceptable prevalence [13], therapies with these antibiotics is discouraged. Based on this, according to the authors of the article, it is reasonable to use bismuth quadruple therapy (bismuth salts, MTZ, TET, and proton pumps inhibitor [PPIs]) as a first line treatment [7,29], because in this case resistance to MTZ does not significantly affect the therapeutic result [30,31]. It should be borne in mind, however, that this applies to strains with low resistance levels (8-32 µg/mL), and higher resistance (>32 µg/mL) may reduce the effectiveness of this therapy from >90% to 60% [32].…”

Section: Discussionmentioning

confidence: 99%

High Primary Antibiotic Resistance of Helicobacter pylori Strains Isolated from Pediatric and Adult Patients in Poland during 2016–2018

et al. 2020

Self Cite

View full text Add to dashboard Cite

Monitoring the antibiotic resistance of H. pylori is an important step in the effective treatment of this bacterium, thus the aim of the present study was to assess the prevalence of antimicrobial resistance of H. pylori strains isolated from pediatric and adult patients with primary infections in 2016–2018. Antral biopsies from 334 treatment-naïve patients (126 children and 208 adults) were obtained. A total of 71 clinical H. pylori strains (22 from children and 49 from adults) were isolated and examined for amoxicillin (AMX), clarithromycin (CLR), metronidazole (MTZ), tetracycline (TET), and levofloxacin (LEV) susceptibility. The activity of the antibiotics was measured by E-tests. Strains were considered as resistant to antibiotics with minimum inhibitory concentrations (MICs) equal to ≥0.125 μg/mL (AMX), ≥0.5 μg/mL (CLR), ≥8 μg/mL (MTZ), and ≥1 μg/mL (TET and LEV). The highest prevalence of antibiotic resistance in H. pylori strains was observed for CLR and MTZ, at frequencies of 54.5% and 31.8% vs. 30.6% and 46.9% for children and adults, respectively. A much lower frequency of isolation of resistant strains was demonstrated for LEV and TET, this being 9.1% and 4.5% vs. 18.4% and 4.1% for pediatric and adult patients, respectively. The presence of AMX-resistant strains was not observed. The H. pylori strains isolated from Polish patients with primary infections showed a high level of antibiotic resistance to CLR and MTZ (>30%).

show abstract

“…However, the eradication rate was only 31.8% as first‐line therapy in our previous study due to the rising prevalence of clarithromycin (29.5%) and metronidazole (42.7%) resistance 7 . Emerging data suggest that this combination has diminished its efficacy 8,9 . The latest guidelines of ESPGHAN/NASPGHAN recommended that if the strain is susceptible to CLA and MET, standard dose triple therapy with MET should be used in place of AMO; if the strain is resistant to CLA, bismuth‐based therapy with tetracycline should be used instead of AMO if the patient is older than 8 years 10 .…”

Section: Introductionmentioning

confidence: 99%

Long‐term changes in the gut microbiota after 14‐day bismuth quadruple therapy in penicillin‐allergic children

Zhou

Miao

et al. 2020

Helicobacter

View full text Add to dashboard Cite

Background Penicillin‐allergic children who are infected with Helicobacter pylori constitute a relatively common subgroup. We aimed to study the short‐term and long‐term effects of bismuth quadruple therapy on gut microbiota in penicillin‐allergic children. Methods We prospectively recruited treatment‐naive children with H pylori infection and H pylori‐negative asymptomatic children as healthy controls. Patients received 14‐day bismuth quadruple therapy consisting of omeprazole, clarithromycin, metronidazole, and bismuth. Fecal samples were collected at weeks 0, 2, 6, and 52. Alterations in the gut microbiota were analyzed by 16S rRNA gene sequencing. Results Twenty‐two subjects (14 gastritis patients, 8 duodenal ulcer patients) and 23 controls participated in this study. At week 2, alpha diversity was reduced in both gastritis (P < .05) and ulcer (except P = .16 with Chao 1 index) patients compared with baseline. Some changes persisted at week 6, and all were restored at week 52. Beta diversity was significantly altered 2 weeks after treatment in the gastritis and duodenal ulcer groups (P = .001, P = .002, respectively) and restored at weeks 6 and 52. The mean relative abundance of Bacteroidetes (P < .001, P = .005, respectively) decreased and that of Proteobacteria increased (P < .001, P = .03, respectively). All alterations recovered at week 6 and 52. In both the gastritis and ulcer groups at week 2, some beneficial bacteria were decreased including Bacteroides (P < .001 and P = .003), Faecalibacterium (P < .001 and P = .02), Phascolarctobacterium (P = .002 and P = .004), Roseburia ( P < .001 and P = .13), Bifidobacterium (P = .08 and P = .04), and Blautia (P < .001 and P = .002). Some detrimental bacteria were increased including Escherichia‐Shigella (P < .001 and P = .19), Klebsiella (P < .001, and P = .09), Enterococcus (P < .001 and P = .007), and Streptococcus (P = .002 and P = .004). The changes returned to almost the pre‐eradication level 1 year after therapy. Conclusion Bismuth quadruple therapy causes short‐term dysbiosis of the gut microbiota. Most changes recovered 1‐year post‐eradication, indicating the long‐term safety of H pylori therapy.

show abstract

Helicobacter pylorifirst‐line and rescue treatments in patients allergic to penicillin: Experience from the European Registry onH pylorimanagement (Hp‐EuReg)

Cited by 27 publications

References 36 publications

European Registry on Helicobacter pylori Management: Effectiveness of First and Second-Line Treatment in Spain

European Registry on Helicobacter pylori Management: Effectiveness of First and Second-Line Treatment in Spain

High Primary Antibiotic Resistance of Helicobacter pylori Strains Isolated from Pediatric and Adult Patients in Poland during 2016–2018

Long‐term changes in the gut microbiota after 14‐day bismuth quadruple therapy in penicillin‐allergic children

Contact Info

Product

Resources

About