Helicobacter pyloritherapy: a paradigm shift

Abstract

SUMMARY Helicobacter pylori (H. Pylori) is a leading cause of gastroduodenal disease, including gastric cancer. H. pylori eradication therapies and their efficacy are summarized. A number of current treatment regimens will reliably yield >90% or 95% cure rates with susceptible strains. None has proven to be superior. We show how to predict the efficacy of a regimen in any population provided one knows the prevalence of antibiotic resistance. As with other infectious diseases, therapy should always be susceptibility-based. Susceptibility testing should be demanded. We provide recommendations for empiric therapies when the only option and describe how to distinguish studies providing misinformation from those providing reliable and interpretable data. When treated as an infectious disease, high H. pylori cure rates are relatively simple to reliably achieve.

Furazolidone, an Underutilized Drug for H. pylori Eradication: Lessons from Iran

“…Successful H. pylori eradication has been defined as one that will reliably achieve an ITT cure rate of at least 90% and/or a 95% or greater PP cure rate in regimen-adherent patients with susceptible infections [46]. In Iran, H. pylori therapy consisting of omeprazole 20 mg, amoxicillin 1,000 mg, and bismuth citrate 240 mg with either 100 or 200 mg of furazolidone, all twice a day failed to reliably achieve this objective.…”

Empiric H. pylori therapy—10-day concomitant, bismuth quadruple or 14-day triple therapy: none is best

“…Thus, fundamentally they were equal (2,3). As shown by their sample size estimation, using first principles, the outcomes could largely be predicted prior to starting the study.…”

“…However, planning and completing a clinical trial takes many years and investigators always risk providing answers to the questions asked may no longer be considered important. During the time the study was in progress the concepts of H. pylori treatment made a transition from a being investigated as other gastrointestinal diseases (e.g., constipation) to becoming recognized as an infectious disease (2–4). All infectious disease therapies are whenever possible susceptibility-based.…”

“…The differences largely resulted from the fact that clarithromycin resistance undermines the effectiveness of clarithromycin containing therapy. However, none of the regimens was optimized in terms of doses or durations (2,8). Their conclusions are thus both population-specific and only applicable to populations with similar patterns of resistance and CYP2C19 genotype, and dose and duration specific.…”

The effect of antioxidants on Helicobacter pylori eradication: A systematic review with meta‐analysis

“…9 Currently, the eradication rate of legacy triple therapy (proton-pump inhibitor [PPI], clarithromycin and amoxicillin) is low, which makes it unacceptable as a first-line treatment for H. pylori according to the Report Card scoring system. 12 Therefore, it is critical to identify an effective regimen in this era of increasing antibiotic resistance. 12 Therefore, it is critical to identify an effective regimen in this era of increasing antibiotic resistance.…”