Optimum duration of regimens for Helicobacter pylori eradication

Yuan, Yuhong; Ford, Alex; Khan, Khurram J.; Forman, David; Oderda, Giuseppina; Calvet, Xavier; Leontiadis, Grigorios I; Fallone, Carlo A; Gisbert, Javier P.; Fischbach, Lori; Bazzoli, Franco; Martin, Paul

doi:10.1002/14651858.cd008337

Cited by 101 publications

(162 citation statements)

References 52 publications

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“…A recent Cochrane systematic review and meta-analysis of RCTs including 45 studies showed that a 14-day clarithromycin-containing triple therapy was more effective than 10-and 7-day regimens yielding an overall eradication rate > 80% (57). This finding confirmed the results of a previous meta-analysis showing that 14-day triple therapy was significantly more effective than 7-day triple therapy (58).…”

Section: First-line Treatmentsupporting

confidence: 68%

Guidelines for the management of Helicobacter pylori infection in Italy: The III Working Group Consensus Report 2015

Zagari

Romano

Ojetti

et al. 2015

Digestive and Liver Disease

115

149

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Knowledge on the role of Helicobacter pylori (HP) infection is continually evolving, and treatment is becoming more challenging due to increasing bacterial resistance. Since the management of HP infection is changing, an update of the national Italian guidelines delivered in 2007 was needed. In the III Working Group Consensus Report 2015, a panel of 17 experts from several Italian regions reviewed current evidence on different topics relating to HP infection. Four working groups examined the following topics: (1) "open questions" on HP diagnosis and treatment (focusing on dyspepsia, gastro-oesophageal reflux disease, non-steroidal anti-inflammatory drugs or aspirin use and extra-gastric diseases); (2) non-invasive and invasive diagnostic tests; (3) treatment of HP infection; (4) role of HP in the prevention of gastric cancer. Statements and recommendations were discussed and a consensus reached in a final plenary session held in February 2015 in Bologna. Recommendations are based on the best current evidence to help physicians manage HP infection in Italy. The guidelines have been endorsed by the Italian Society of Gastroenterology and the Italian Society of Digestive Endoscopy.

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Section: First-line Treatmentsupporting

confidence: 68%

Guidelines for the management of Helicobacter pylori infection in Italy: The III Working Group Consensus Report 2015

Zagari

Romano

Ojetti

et al. 2015

Digestive and Liver Disease

115

149

View full text Add to dashboard Cite

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“…Yuan et al reported that prolonged duration of PPI-based TT significantly increases eradication rate 24. In the present guidelines, it is suggested that the duration of clarithromycin-based TT be extended as previous meta-analyses have indicated that 10-day and 14-day treatment regimens improve H. pylori eradication rate when compared with 7-day treatment regimen 4 25–27.…”

Section: Discussionmentioning

confidence: 89%

First-lineHelicobacter pylorieradication therapies in countries with high and low clarithromycin resistance: a systematic review and network meta-analysis

Yeo

Shiu

et al. 2016

Gut

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Objective To determine the optimal regimen of different first-line Helicobacter pylori eradication therapies according to the clarithromycin resistance rate. Design Electronic search for articles published between January 2005 and April 2016. Randomised, controlled trials that reported the effectiveness of first-line eradication therapies in treatment-naïve adults were included. Two independent reviewers performed articles screening and data extraction. Network and traditional meta-analyses were conducted using the random effect model. Subgroup analyses were performed to determine the ranking of regimens in countries with high (>15%) and low (<15%) clarithromycin resistance. Data including adverse events and therapeutic cure rate were also extracted and analysed. Results 117 trials (totally 32 852 patients) for 17 H. pylori eradication regimens were eligible for inclusion. Compared with 7-day clarithromycin-based triple therapy, sequential therapy (ST) for 14 days had the highest effectiveness (OR=3.74, 95% CrI 2.37 to 5.96). ST-14 (OR=6.53, 95% CrI 3.23 to 13.63) and hybrid therapy (HY) for 10 days or more (OR=2.85, 95% CrI 1.58 to 5.37) represented the most effective regimen in areas with high and low clarithromycin resistance, respectively. The effectiveness of standard triple therapy was below therapeutic eradication rate in most of the countries. Longer duration was associated with higher eradication rate, but with a higher risk of events that lead to discontinuation. Conclusions ST and HY appeared to be the most effective therapies in countries with high and low clarithromycin resistance, respectively. The clinical decision for optimal regimen can be supported by referring to the rank ordering of relative efficacies stratified by local eradication rates, antibiotic resistance and safety profile. Trial registration number CRD42015025445.

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“…Studies have looked to find the optimal length of therapy222324 but potential treatment durations are based on empirical evidence. This study used a mathematical model as a way to determine the time to eradication of the infection and therefore the minimum duration of treatment required.…”

Section: Discussionmentioning

confidence: 99%

Optimising Antibiotic Usage to Treat Bacterial Infections

Paterson

Hoyle

Ochoa

et al. 2016

Sci Rep

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The increase in antibiotic resistant bacteria poses a threat to the continued use of antibiotics to treat bacterial infections. The overuse and misuse of antibiotics has been identified as a significant driver in the emergence of resistance. Finding optimal treatment regimens is therefore critical in ensuring the prolonged effectiveness of these antibiotics. This study uses mathematical modelling to analyse the effect traditional treatment regimens have on the dynamics of a bacterial infection. Using a novel approach, a genetic algorithm, the study then identifies improved treatment regimens. Using a single antibiotic the genetic algorithm identifies regimens which minimise the amount of antibiotic used while maximising bacterial eradication. Although exact treatments are highly dependent on parameter values and initial bacterial load, a significant common trend is identified throughout the results. A treatment regimen consisting of a high initial dose followed by an extended tapering of doses is found to optimise the use of antibiotics. This consistently improves the success of eradicating infections, uses less antibiotic than traditional regimens and reduces the time to eradication. The use of genetic algorithms to optimise treatment regimens enables an extensive search of possible regimens, with previous regimens directing the search into regions of better performance.

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Optimum duration of regimens for Helicobacter pylori eradication

Cited by 101 publications

References 52 publications

Guidelines for the management of Helicobacter pylori infection in Italy: The III Working Group Consensus Report 2015

Guidelines for the management of Helicobacter pylori infection in Italy: The III Working Group Consensus Report 2015

First-lineHelicobacter pylorieradication therapies in countries with high and low clarithromycin resistance: a systematic review and network meta-analysis

Optimising Antibiotic Usage to Treat Bacterial Infections

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