P.10.10 Rescue Therapy With Bismuth Quadruple Regimen in Patients With Helicobacter Pylori -Resistant Strains

Fiorini, Giulia; Saracino, I.M.; Zullo, Angelo; Gatta, Luigi; Pavoni, Matteo; Vaira, Berardino

doi:10.1016/s1590-8658(18)30645-5

Cited by 3 publications

(4 citation statements)

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“…Overall, of the 57 relevant references initially identified, 30 studies met the inclusion criteria and were included in the systematic review and meta‐analysis (Figure ). During the full‐text review stage, the authors of five primary studies were contacted for data clarification.…”

Section: Resultsmentioning

confidence: 99%

“…The effectiveness of rescue therapies depends directly on the prior exposure to antibiotics, with strains surviving any attempt at eradication tending to become more resistant or resilient to further treatment . Although there is little data available showing the efficacy of the single capsule as a rescue therapy, there is evidence from a few studies that 10‐days of omeprazole and three‐in‐one bismuth‐containing single capsule is an effective rescue therapy in patients infected with antibiotic‐resistant strains of H pylori . Hence, the aim of this study was to perform a systematic review and meta‐analysis of the studies evaluating the efficacy and safety of BQT with three‐in‐one bismuth‐containing single capsule (Pylera ® ) plus a PPI as any line of treatment to eradicate H pylori .…”

Section: Introductionmentioning

confidence: 99%

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Meta‐analysis of three‐in‐one single capsule bismuth‐containing quadruple therapy for the eradication of Helicobacter pylori

2019

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Background Bismuth‐containing quadruple therapy has been suggested as first‐line and rescue alternative for Helicobacter pylori eradication. Our objective was to perform a meta‐analysis evaluating the efficacy and safety of single capsule Pylera® (bismuth, metronidazole, and tetracycline) plus a proton‐pump inhibitor (PPI) in any line of treatment. Methods Studies were selected up to October 2018. Outcomes were eradication and adverse events (AEs) rates pooled using the generic inverse variance method. Results In total, 30 studies (6482 patients) were included in the systematic review. The intention‐to‐treat (ITT) efficacy was 90% (95% CI: 87%‐92%, 21 studies, I2 = 88%) in first‐line therapy, 89% (95% CI: 86%‐93%, 12 studies, I2 = 78%) in second‐line and 82% (95% CI: 78%‐87%, nine studies, I2 = 60%) in third‐line; with no differences by the type or dosage of PPI used. For metronidazole‐resistant infection, the ITT efficacy as first‐line therapy was 93% (95% CI: 90%‐96%, six studies, I2 = 0%). In second‐line therapies where patients had been previously treated with clarithromycin, the ITT efficacy was 90% (95% CI: 87%‐93%, 11 studies, I2 = 78%). The overall incidence of AEs was 43% (95% CI: 35%‐50%, 24 studies, I2 = 92%) and they were mostly mild. In nearly 3% of the cases, treatment was interrupted due to AEs. Conclusions A 10‐day treatment with Pylera® achieved an effective eradication rate of approximately 90% both in first‐ and second‐line therapy. This applies regardless of the type and dose of the PPI, in patients with clarithromycin‐ or metronidazole‐resistant strains, and in those previously treated with clarithromycin.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Meta‐analysis of three‐in‐one single capsule bismuth‐containing quadruple therapy for the eradication of Helicobacter pylori

2019

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“…For instance, clarithromycin‐ or metronidazole‐based eradication regimes may still remain a reasonable first‐line empirical option for native Singaporeans, while a susceptibility‐based eradication approach should be strongly advocated for non‐natives. If culture and susceptibility testing are not available, a bismuth‐based quadruple regimen may be considered as upfront therapyyy 29 particularly in non‐resident individuals at high risk for carrying multiresistant strains. A risk‐based approach, together with continued efforts to enforce patient compliance to therapy, would possibly improve current eradication rates toward the benchmark of 90%–95%.…”

Section: Discussionmentioning

confidence: 99%

Antibiotic resistance patterns and therapeutic outcomes of pediatric Helicobacter pylori infection in a high‐migrant Singaporean cohort

Huang

Lim

et al. 2021

Helicobacter

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Background Variation in Helicobacter pylori (H. pylori) disease in terms of prevalence and antibiotic resistance prevails globally requiring a need to develop region‐specific surveillance. We aimed to assess the influence of immigration factors upon the interpretation of local Singaporean epidemiological trends in antimicrobial susceptibility patterns and therapeutic outcomes in children with culture‐positive H. pylori. Materials and Methods We retrospectively analyzed eradication outcomes of children with culture‐proven H. pylori infections between 2011 and 2020 at our center, and we also analyzed the antimicrobial susceptibility profiles of the corresponding H. pylori isolates. The cohort was classified into two groups: (1) Native Singaporeans and (2) Non‐native Singaporeans (First‐/Second‐generation immigrants and Non‐residents) to correlate with resistance patterns and eradication outcomes. H. pylori culture was done via Kirby‐Bauer disk diffusion for the era 2011–2016 and bioMérieux E test for 2016–2020. Results A total of 70 children (median age 14 [2–17] years) were included in the analysis. 42.9% (30/70) of the cohort displayed some form of antibiotic resistance; clarithromycin resistance was the most prevalent (30.0%), followed by metronidazole (27.5%) and amoxicillin (7.1%). Comparing to natives, non‐native Singaporeans were significantly younger at presentation (mean 11.7 vs. 13.7 years, p = 0.043), and a significantly higher proportion of non‐natives carried clarithromycin‐resistant (51.4% vs. 8.6%, p < 0.001), metronidazole‐resistant (47.1% vs. 8.6%, p < 0.001), or multidrug‐resistant (resistant to ≥2 drugs) (40.0% vs. 2.9%, p < 0.001] strains. Non‐natives were significantly more likely to fail first‐line eradication therapy (48.5% failure vs. 23.3%, p = 0.038). The proportion of pan‐sensitive H. pylori was significantly lower in first‐generation (25.0%, p = 0.001) and second‐generation (42.9%, p = 0.018) immigrants compared to natives (82.86%). These conclusions did not vary when the analysis was repeated for each culture method. Conclusions An antibiotic susceptibility‐based approach should be advocated for all patients but especially so for non‐natives, who are at higher risk for antimicrobial resistant strains and poorer eradication outcomes.

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“…Bismuth also aids ulcer healing by increasing mucosal protective factors such as prostaglandin, epidermal growth factor, and bicarbonate secretion . In areas with multiresistant strains of H. pylori and high rates of antibiotic resistance, bismuth rescue therapy is an effective treatment option, with eradication rates as high as 97.6% . BQT is commonly recommended in treatment guidelines as a rescue therapy and as first‐line therapy in areas of high resistance.…”

Section: Bismuthmentioning

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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P.10.10 Rescue Therapy With Bismuth Quadruple Regimen in Patients With Helicobacter Pylori -Resistant Strains

Cited by 3 publications

References 0 publications

Meta‐analysis of three‐in‐one single capsule bismuth‐containing quadruple therapy for the eradication of Helicobacter pylori

Meta‐analysis of three‐in‐one single capsule bismuth‐containing quadruple therapy for the eradication of Helicobacter pylori

Antibiotic resistance patterns and therapeutic outcomes of pediatric Helicobacter pylori infection in a high‐migrant Singaporean cohort

Treatment of Helicobacter pylori infection in 2018

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