Ideal treatment for Helicobacter pylori: A systematic review

Abstract

Background: The success rates of therapies for treating Helicobacter pylori vary greatly worldwide and the ideal treatment has yet to be clearly established. Aims: A systematic review was carried out to evaluate the effectiveness of current first and second-line therapies in treating H. pylori infection. Methods: Two researchers independently carried out Internet search engine reviews (PUBMED, EMBASE, MEDLINE) of clinical trials on adults published between 1990 and 2012 in both English and Spanish. Results: Forty-three (n = 8,123) clinical trials were evaluated that included first and second-line triple, quadruple, and sequential therapies. The eradication rates of the standard triple therapy are unacceptable (≤ 80%) in countries where H. pylori is highly resistant to clarithromycin and metronidazole. Administration of the standard triple therapy for more than 7 days does not improve its effectiveness. No statistically significant differences were observed between the eradication rates of the quadruple therapy with bismuth and the standard triple therapy. Even though the sequential and concomitant therapies are equally successful regimens, the triple therapy with levofloxacin offers the best results as first and second-line treatment, but quinolone resistance can diminish its effectiveness. The triple therapy with levofloxacin and the sequential and concomitant treatments were superior to the standard triple regimen as first-line therapy. Conclusions: Currently there is no ideal first or second-line treatment for achieving 100% eradication. The therapeutic order should be carried out according to the initial treatment and local antimicrobial resistance studies. Tratamiento ideal del Helicobacter pylori: una revisión sistemática ResumenAntecedentes: Las tasas de éxito de las terapias para tratar el Helicobacter pylori varían ampliamente a nivel mundial. El tratamiento óptimo no ha sido claramente establecido. Objetivo: Se realizó un revisión sistemática para evaluar la eficacia de las terapias actuales de primera y segunda línea en la infección por Helicobacter pylori. Métodos: Dos investigadores realizaron la revisión independiente en motores de búsqueda electrónica (PUBMED, EMBASE, MEDLINE) de ensayos clínicos publicados entre 1990 y 2012, incluyendo adultos e idiomas inglés y español. Resultados: Se evaluaron 43 ensayos clínicos (n = 8,123), que incluyen terapias triples, cuádruples y secuenciales, de primera y segunda línea. Las tasas de erradicación de la terapia triple estándar son inaceptables (≤ 80%) en países donde el H. pylori presenta alta resistencia a claritromicina y metronidazol. Un tiempo mayor a 7 días no mejora la eficacia de la triple terapia estándar. No se observaron diferencias significativas entre las tasas de erradicación de la terapia cuádruple con bismuto y la triple terapia estándar. Aunque las terapias secuencial y concomitante son regímenes igualmente exitosos, la terapia triple con levofloxacino ofrece los mejores resultados como primera y segunda línea, pero la resistencia a quinolon...

Capsule in Capsule Dosage Form With Mini Tablets for the Treatment of Helicobacter Pylori

“…The standard triple therapy is a proton pump inhibitor (PPI) and 2 or 3 antibiotics, levofloxacin containing triple therapy, Bismuthcontaining quadruple therapy, sequential therapy and Concomitant therapy. 5,6 The first line treatment is the PPI based triple therapy (Lansoprazole + Clarithromycin + Amoxicillin) which is approved by the US-FDA. 7 The current therapy includes different dosage forms in high doses, which may cause inconvenience to the patient and can cause dose dumping and toxicity.…”

Efficacy and safety of triple therapy containing berberine hydrochloride, amoxicillin, and rabeprazole in the eradication of Helicobacter pylori

“…In 2015, the Kyoto consensus defined H. pylori gastritis as an infectious disease, and recommended eradication therapy for all adult patients infected with H. pylori . Theoretically, the eradication rate of should reach 80% or higher, and that of the optimal treatment scheme should be over 95% 9 . However, the validity of H. pylori eradication therapy shows a gradual downward trend globally.…”

“…Theoretically, the eradication rate of should reach 80% or higher, and that of the optimal treatment scheme should be over 95%. 9 However, the validity of H. pylori eradication therapy shows a gradual downward trend globally. Eradication failure is mainly attributed to antibiotic resistance, variation among bacterial strains and hosts, as well as ineffective treatments.…”

Effect of Lemon Oil Concentrate Cymbopogon citratus ERILIM® towards the Helicobacter pylori Bacteria: A Case Report

“…The symptoms are gastritis, dyspepsia, gastroesophageal reflux and pain in the epigastrium. However, these symptoms can become chronic, progressive and of enormous evolution; the mucosa is injured so much that gastric ulcers, internal bleeding and even a gastric lymphoma associated with MALT can occur [10,11,12].…”

“…They were taken into account for this systematic review to define the optimal treatment towards H. pylori which causes symptoms that can vary significantly worldwide. Nowadays, there is no ideal therapeutic strategy to eradicate H. pylori infection in 100% of cases [12,13]. The system of treatments for this Gramnegative bacterium is not the best.…”