Letter: could sequential therapy extended to 14 days replace prolonged triple regimens for <i>Helicobacter pylori</i> treatment?

Losurdo, Giuseppe; Iannone, Andrea; Giorgio, Floriana; Principi, M.; Leo, Alfredo Di; Ierardi, Enzo

doi:10.1111/apt.13544

Cited by 5 publications

(3 citation statements)

References 8 publications

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“…A prolongation of treatment duration to 14 days could be beneficial in areas where effectiveness started to decline, as described by Yadollahi et al 34 Otherwise, 14‐day CT has not been investigated in depth, and most reports described an effectiveness similar to that reported in our study 35 . Such an approach has been already applied to sequential therapy to find a minimal, not statistically significant, increase in the eradication rate 36 …”

Section: Discussionsupporting

confidence: 52%

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Effect of metronidazole resistance on Helicobacter pylori eradication regimens

Losurdo

Pricci

Bellis

et al. 2022

J of Digest Diseases

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Objectives Guidelines suggest bismuth‐containing quadruple therapy (BQT) or concomitant therapy (CT) as first‐line therapy in our geographic area. Both schedules contain metronidazole. We aimed to evaluate the effect of metronidazole resistance to Helicobacter pylori (H. pylori) eradication therapy. Methods We recruited treatment‐naïve subjects with H. pylori infection who received either CT or BQT during January 2020 and December 2021. Before therapy, a fecal sample was collected using the THD fecal test device from each patient. H. pylori DNA was extracted and mutations of rdxA and frxA genes and A2143G for metronidazole and clarithromycin resistance were investigated using real‐time polymerase chain reaction with a high‐resolution melting curve. Results Ninety‐six patients were enrolled, including 29 received BQT and 67 received CT. The overall eradication rate was 94.8% (100% for BQT and 92.5% for CT). Metronidazole resistance was found in 18 (18.8%) subjects, while clarithromycin resistance was found in 19 (19.8%). All 18 patients with metronidazole resistance achieved successful eradication (five treated with BQT and 13 with CT). The eradication rate in metronidazole‐sensitive strains was 93.6%. Of these, 24 received BQT with 100% success, and 54 had CT with five failures (successful eradication in 90.7%). Two patients with treatment failure were resistant to clarithromycin, and the remaining three were susceptible to both clarithromycin and metronidazole. No statistical significance was observed in the eradication rate between metronidazole‐resistant and ‐sensitive strains (100% vs 93.6%, P = 0.58). Conclusion Metronidazole resistance does not influence the eradication rate of BQT and CT regimens in our geographical area, even if such results need to confirmed in a larger sample.

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Section: Discussionsupporting

confidence: 52%

“…35 Such an approach has been already applied to sequential therapy to find a minimal, not statistically significant, increase in the eradication rate. 36 Genotypic resistance investigation has some undoubted benefits.…”

Section: Discussionmentioning

confidence: 99%

Effect of metronidazole resistance on Helicobacter pylori eradication regimens

Losurdo

Pricci

Bellis

et al. 2022

J of Digest Diseases

View full text Add to dashboard Cite

show abstract

“… 5 Sequential therapy extending from 10 days to 14 days potentially had better eradication efficacy. 6 Nevertheless, previous studies found that 10-day standard bismuth quadruple therapy achieved high efficacy for first-line H. pylori eradication, as determined by intention-to-treat (ITT) analyses (≥90%) and per-protocol (PP) analyses (≥95%) 7 , 8 , 9 ; thus, extending bismuth quadruple therapy from 10 days to 14 days might have a limited effect on the eradication rate. However, females have higher antibiotic resistance rates in H. pylori infection than males do.…”

Section: Introductionmentioning

confidence: 99%