Impact ofLactobacillus reuteriSupplementation on Anti-Helicobacter pyloriLevofloxacin-Based Second-Line Therapy

Abstract

Introduction. Helicobacter pylori eradication therapy has the potential burden of antibiotic-associated gastrointestinal (GI) side effects. The occurrence of side effects is among the major drawbacks of such regimens. GI manifestations may be related to alterations in the intestinal microflora. Probiotics can prevent or reduce antibiotic-associated side effects and have an inhibitory effect on H. pylori. Methods. To define the efficacy of Lactobacillus reuteri supplementation in H. pylori eradication and in preventing GI-associated side effects during a second-line levofloxacin triple therapy. 90 H. pylori-positive patients receive for 7 days a second-line triple therapy with esomeprazole, levofloxacin, and amoxicillin with L. reuteri for 14 days (group 1) and without probiotic supplementation (group 2). Each subject received a validated questionnaire to record symptoms everyday for 4 weeks from the start of therapy. H. pylori status and side effects were assessed 6 weeks after treatment. Results. The eradication rate was significantly influenced by probiotic supplementation with L. reuteri (group 1: 36/45, 80%; group 2: 28/45 62%; P < 0.05). The incidence of nausea and diarrhoea in group 1 was significantly lower than that in group 2. Conclusion. In H. pylori-positive subjects L. reuteri supplementation increases the eradication rate while reducing the incidence of the most common side effects associated with antibiotic therapy in second-line treatment.

Lactobacillus reuteri in management of Helicobacter pylori infection in dyspeptic patients: a double-blind placebo-controlled randomized clinical trial

“…Addition of L. reuteri to the triple therapy reduced the frequency of side effects, particularly diarrhea; this should improve patient compliance and adherence to therapy. Similar results were reported from different studies that used L. reuteri as adjuvant to the triple therapy in H. pylori eradication [Francavilla et al 2008;Scaccianoce et al 2008;Efrati et al 2012;Ojetti et al 2012]. Although all patients in the present study were compliant with the regimen prescribed, in daily clinical practice reduced side effects would increase the patients' compliance especially with retreat patients who experienced side effects with previous triple therapies and therefore were not motivated to be retreated due to intolerable side effects.…”

Lactobacillus -containing probiotic supplementation increases Helicobacter pylori eradication rate: evidence from a meta-analysis

“…Loss-up rates were less than 20 %. − Participants were assessed by 13 C-urea breath test, histology, and stool antigen test. At least one positive test result was considered as confirmation of infection.…”

“…Of all trials, sequence generation (method of randomization) was clear and appropriate. Concealment was unclear in 7 studies (12,13,16,(23)(24)(25)(26), which was performed by using appropriately sealed boxes in 2 studies (14,27). Knowledge of the assigned intervention may impact on behavioral outcomes (such as number of clinic visits) but not on physiological outcomes.…”

“…Deguchi et al (12) indicated a significant improvement in eradication rate with yogurtplus-triple treatment (PPI + amoxicillin + clarithromycin + probiotic for 7 days). Ojetti et al (13) also concluded the result that the eradication rate of second-line triple therapy raised by 18 % with probiotic supplementation, and the incidence of nausea and diarrhea reduced distinctly. However, the addition of probiotics obtained a significant decrease of side effects, while there was no statistical alteration of eradication in the trial of Manfredi (14).…”

Primera guía clínica basada en la evidencia médica para la suplementación con probióticos en la farmacia comunitaria española

“…Hoy día existe más de un centenar de sistemas de clasificación de las evidencias que deberían fundamentar las decisiones clínicas. Estos sistemas son la base para la elaboración de las Guías de Práctica Clínica (conjunto de recomendaciones basadas en una revisión sistemática de la evidencia y en la evaluación de los riesgos y beneficios de las diferentes alternativas, con el objetivo de optimizar la atención sanitaria a los pacientes) [5]. En nuestro país "GuíaSalud", organismo del Sistema Nacional de Salud (SNS) en el que participan las 17 Comunidades Autónomas y el Ministerio de Sanidad y que fue creado en el 2002 y adoptado en 2003 por el Consejo Interterritorial como instrumento para mejorar la calidad de la atención sanitaria en el SNS, ha construido el portal guiasalud.es [6] que provee de la información necesaria para la elaboración de las guías.…”