Nonbismuth Quadruple (Concomitant) Therapy: Empirical and Tailored Efficacy versus Standard Triple Therapy for Clarithromycin‐Susceptible <i>Helicobacter pylori</i> and versus Sequential Therapy for Clarithromycin‐Resistant Strains

Molina–Infante, Javier; Pazos-Pacheco, Carmen; Vinagre-Rodríguez, Gema; Perez-Gallardo, Belen; Dueñas-Sadornil, Carmen; Hernández-Alonso, Moisés; González-García, Guadalupe; Mateos-Rodríguez, José María; Fernandez-Bermejo, Miguel; Gisbert, Javier P.

doi:10.1111/j.1523-5378.2012.00947.x

Cited by 78 publications

(46 citation statements)

References 36 publications

(51 reference statements)

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“…11 More recently, multiple trials of concomitant NBQT have confirmed an ITT eradication rate of 75-96.4% (per-protocol rates consistently superior to 80%) with a possible advantage for longer treatment duration (Table 3). 15,16,[21][22][23][24][25][26][27][28][29][30][31][32] The results of this randomized trial appear to confirm our earlier observation 13 that reduced-dose regimens (down to 50% posology) performs similarly to standard-dose regimens with the added benefit of reduced cost and adverse events. To date, three randomized controlled trials, involving a total of 475 patients, have examined the value of 50% reduction in the dose of all administered antibiotics for H. pylori (two STT and the current concomitant NBQT) and have all confirmed similar eradication rates to the standard-dose comparator (Table 4), with a reduction in adverse events and cost.…”

Section: Discussionsupporting

confidence: 80%

Challenging the dogma: a randomized trial of standard vs. half‐dose concomitant nonbismuth quadruple therapy for Helicobacter pylori infection

et al. 2014

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Background: Current treatment of Helicobacter pylori consists of three or four drugs for 7-14 days with important associated cost and adverse events. Aims: This study compared efficacy and safety of standard dose vs. half-dose concomitant nonbismuth quadruple therapy (NBQT) for 7 days. The standard dose consisted of twice daily rabeprazole 20 mg, amoxicillin 1 g, metronidazole 500 mg, and clarithromycin 500 mg. Methods: This was a prospective randomized trial.14 C-urea breath test was performed !4 weeks after treatment and !2 weeks off acid suppressive therapy. Compliance and adverse events were monitored during treatment. Results: A total of 200 consecutive treatment-naïve patients were enrolled. Baseline characteristics were similar between groups, with 15.5% of subjects reporting prior macrolide use. Eradication occurred in 78% (95% CI 68.6-85.7%) in both groups on intention-to-treat analysis. Per-protocol rates were 82.1 vs. 83.9% for standard-dose patients vs. half-dose patients, respectively (p ¼ NS). Adverse events (only mild) were reported in 57 vs. 41% of standard-dose patients vs. half-dose patients (p ¼ 0.024), with metallic taste and nausea notably less frequent in the latter (36 vs. 12% and 18 vs. 7%, respectively; p < 0.05 for both). Overall, eradication failed in 38.7% of prior macrolide users vs. 18.9% without such exposure (p ¼ 0.019). On multivariate logistic regression, prior macrolide exposure was the only factor associated with failed eradication (OR 2.60, 95% CI 1.06-6.39; p ¼ 0.038). Treatment was cheaper with the half-dose regimen. Interpretation: A 50% reduction in antibiotic dosage does not diminish efficacy of concomitant nonbismuth quadruple therapy but leads to significant reduction in cost and adverse events. Seven-day concomitant NBQT is suboptimal for H. pylori independent of prior macrolide exposure.

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Section: Discussionsupporting

confidence: 80%

Challenging the dogma: a randomized trial of standard vs. half‐dose concomitant nonbismuth quadruple therapy for Helicobacter pylori infection

et al. 2014

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“…Recently, several studies have compared concomitant therapy to STT and sequential therapy. In one study, 10-d concomitant therapy resulted in a better eradication rate in settings with antibiotic-resistant H. pylori strains [97] . Eradication rates for concomitant and sequential therapies were 100% vs 75% for clarithromycin-resistant strains and 75% vs 60% for clarithromycin-resistant/metronidazoleresistant strains [97] .…”

Section: Are There Suitable Sequential and Concomitant Therapy Alternmentioning

confidence: 99%

“…In one study, 10-d concomitant therapy resulted in a better eradication rate in settings with antibiotic-resistant H. pylori strains [97] . Eradication rates for concomitant and sequential therapies were 100% vs 75% for clarithromycin-resistant strains and 75% vs 60% for clarithromycin-resistant/metronidazoleresistant strains [97] . A meta-analysis of 15 studies showed a mean H. pylori eradication rate of 90% by ITT analysis for concomitant therapy and reported that longer treatment improved the outcomes compared to STT [98] .…”

Section: Are There Suitable Sequential and Concomitant Therapy Alternmentioning

confidence: 99%

Antibiotic treatment forHelicobacter pylori: Is the end coming?

Kim

Choi

Chung

2015

WJGPT

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Infection with the Gram-negative pathogen Helicobacter pylori (H. pylori ) has been associated with gastroduodenal disease and the importance of H. pylori eradication is underscored by its designation as a group I carcinogen. The standard triple therapy consists of a proton pump inhibitor, amoxicillin and clarithromycin, although many other regimens are used, including quadruple, sequential and concomitant therapy regimens supplemented with metronidazole, clarithromycin and levofloxacin. Despite these efforts, current therapeutic regimens lack efficacy in eradication due to antibiotic resistance, drug compliance and antibiotic degradation by the acidic stomach environment. Core tip: This article reviews the recent literature describing antibiotic resistance and trends in Helicobacter pylori (H. pylori ) treatment. As there is no effective conventional therapy, new treatments are being developed and bismuth quadruple, sequential, concomitant therapies are recommended as a first-line regimen in regions with high levels of clarithromycin resistance. Quinolones have also been used for H. pylori treatment, although the cure rate has gradually reduced with this approach. New therapeutic directions include probiotic supplementation, tailored therapy, novel agents, and nanotechnology.

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“…It was successful in several trials and especially on clarithromycin resistant strains in a Spanish trial. 60 A review of this therapy involving 2070 patients from 19 studies obtained a mean eradication rate of 88%. 61 There are also some attempts to combine the 2 approaches, sequential and concomitant, by prescribing a 14-d sequential regimen but continuing amoxicillin during the entire period, the so-called hybrid therapy.…”

Section: Sequential or Concomitant Non-bismuth Quadruple Therapiesmentioning

confidence: 99%

Current recommendations forHelicobacter pyloritherapies in a world of evolving resistance

Mégraud

2013

Gut Microbes

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Nonbismuth Quadruple (Concomitant) Therapy: Empirical and Tailored Efficacy versus Standard Triple Therapy for Clarithromycin‐Susceptible Helicobacter pylori and versus Sequential Therapy for Clarithromycin‐Resistant Strains

Cited by 78 publications

References 36 publications

Challenging the dogma: a randomized trial of standard vs. half‐dose concomitant nonbismuth quadruple therapy for Helicobacter pylori infection

Challenging the dogma: a randomized trial of standard vs. half‐dose concomitant nonbismuth quadruple therapy for Helicobacter pylori infection

Antibiotic treatment forHelicobacter pylori: Is the end coming?

Current recommendations forHelicobacter pyloritherapies in a world of evolving resistance

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