Impact of primary antibiotic resistance on the effectiveness of sequential therapy for <i>Helicobacter pylori</i> infection: lessons from a 5‐year study on a large number of strains

Gatta, Luigi; Scarpignato, Carmelo; Fiorini, Giulia; Belsey, Jonathan; Saracino, Ilaria Maria; Ricci, Carlo; Vaira, Dino

doi:10.1111/apt.14597

Cited by 47 publications

(46 citation statements)

References 37 publications

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“…In a recent AP&T publication from Italy, in which 1325 cultured H. pylori strains were evaluated before sequential therapy was prescribed, Gatta and colleagues report a progressive increase in in vitro resistance to one or more of clarithromycin, metronidazole and levofloxacin over the period from 2010 to 2015, continuing a trend that started in 2001 . During this time, only 39% of strains were susceptible in vitro to all 3 of these antibiotics.…”

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confidence: 99%

Editorial: Helicobacter pylori resistance and sequential therapy

Siddique

Moss

2018

Aliment Pharmacol Ther

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mentioning

confidence: 99%

Editorial: Helicobacter pylori resistance and sequential therapy

Siddique

Moss

2018

Aliment Pharmacol Ther

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“…The reverse hybrid therapy (PPI plus amoxicillin for 14 days, and clarithromycin plus metronidazole for the initial 7 days) has been proposed as a means of simplifying it. 19 16 A prospective cross-sectional study conducted in Spain found very impressive eradication rates of 98% for concomitant quadruple therapy compared to 94% for bismuth-based quadruple therapy.…”

Section: Quadruple Con Comitant S Equential and Hyb Rid Ther Amentioning

confidence: 99%

“…18 Regarding the sequential therapy, which was proposed as a means of overcoming antibiotic resistance, an interesting study from Italy where H pylori primary resistance to antimicrobials tested is high showed eradication rates for 10-day sequential therapy of 97% in strains susceptible to clarithromycin and metronidazole, 96% in strains resistant to metronidazole, 93% in strains resistant to clarithromycin, and surprisingly even 83% in strains resistant to both clarithromycin and metronidazole. 19…”

Section: Quadruple Con Comitant S Equential and Hyb Rid Ther Amentioning

confidence: 99%

Review: Treatment of Helicobacter pylori Infection 2019

et al. 2019

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This review summarizes important studies regarding Helicobacter pylori therapy published from May 2018 to May 2019. The main themes that emerge involve studies assessing the efficacy of bismuth‐based regimens. While in recent years the efficacy of bismuth‐based quadruple therapy as a second‐line therapy has been clearly established, there is now substantial evidence that it is the best performing first‐line therapy. Antibiotic resistance was again intensely studied this year, and a clear and dramatic increase in resistance is noted for clarithromycin and levofloxacin; most notably, it may not be possible to support these therapies in most regions of the world much longer without testing. The utility of vonoprazan as an alternative to proton‐pump inhibitor therapy, especially in resistant and difficult to treat groups, has also been considered in greater detail this year, as well as means of supporting and enhancing adherence to therapy. Several studies showed that the diversity of gut microbiota was significantly altered shortly after H pylori eradication. However, the diversity was restored to pre‐treatment state after 2 months in patients treated with triple therapy. More studies are warranted to assess the long‐term changes of gut microbiota after H pylori eradication.

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“…A 5‐year prospective review in Italy assessed antimicrobial resistance to clarithromycin, metronidazole, and levofloxacin before giving 10‐day sequential therapy as first‐line therapy. Even in patients with dual resistance, 10‐day sequential therapy was 83.1% effective in treating the underlying H. pylori infection . A Turkish study highlighted the role for 5 + 5 clarithromycin‐based sequential therapies in areas with low clarithromycin resistance rates, which was found to be superior to 14‐day triple therapy and BQT …”

Section: Sequential and Concomitant Therapymentioning

confidence: 99%

“…Levofloxacin remains one of the most favored second‐line therapies; however, bismuth, when available, is an increasingly successful option. Sequential therapy remains in use in areas of high resistance, but may prove challenging in terms of compliance, and is no longer recommended . Three‐in‐one formulations of bismuth quadruple therapy (BQT) may improve compliance .…”

Section: Introductionmentioning

confidence: 99%

Treatment of Helicobacter pylori infection in 2018

et al. 2018

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Treatment options for the eradication of Helicobacter pylori continue to evolve. There have been many guidelines for H. pylori treatment published, which may lead to some confusion. However, most are in agreement with the most recent iteration of the Maastricht treatment guidelines. Triple therapy is still the most frequently used treatment, especially in areas of low clarithromycin resistance. Its best results are achieved when taken for a minimum of 10 days and with high-dose acid suppression. Quadruple therapy is gaining in popularity particularly in areas with increasing resistance to standard triple therapy. Whether three antibiotics, or bismuth and two antibiotics are used, excellent eradication rates are achieved, albeit with increased side effects. Levofloxacin second-line therapy is widely used; however bismuth, when available, is an increasingly successful option. Sequential therapy is challenging in terms of compliance and is no longer recommended. This past year witnessed a notable increase in the number of studies based on antimicrobial susceptibility testing and tailored eradication therapy, reflecting the role of culture-guided treatment, which may well represent the future of H. pylori treatment and prevent the inappropriate use of antibiotics.

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Impact of primary antibiotic resistance on the effectiveness of sequential therapy for Helicobacter pylori infection: lessons from a 5‐year study on a large number of strains

Cited by 47 publications

References 37 publications

Editorial: Helicobacter pylori resistance and sequential therapy

Editorial: Helicobacter pylori resistance and sequential therapy

Review: Treatment of Helicobacter pylori Infection 2019

Treatment of Helicobacter pylori infection in 2018

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