Pylera and sequential therapy for first-line Helicobacter pylori eradication: a culture-based study in real clinical practice

Fiorini, Giulia; Zullo, Angelo; Saracino, Ilaria Maria; Gatta, Luigi; Pavoni, Matteo; Vaira, Dino

doi:10.1097/meg.0000000000001102

Cited by 34 publications

(30 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In almost 3% of the cases, treatment was discontinued due to AEs. [16][17][18]27,[30][31][32]34,35,37,38,[42][43][44][45]47…”

Section: Safety Of Pylera ®mentioning

confidence: 99%

“…Fiorini (2017b),, De Francesco (2018) andFiorini (2018) used double doses PPI (esomeprazole 20 mg bid); Gómez-Rodríguez (2017) and Rodríguez de Santiago (2017) used double dosis PPI (omeprazole 40 mg bid); Rodriguez de Santiago (2017), Perez-Arellano (2017), Gravina (2018), Tarhini (2018) and Ciccaglione (2018) used high-dosage PPI (esomeprazole 40 mg bid) and were also excluded from the sensitivity analyses. c Rodriguez de Santiago (2017), Pérez Arellano (2017), Gravina (2018), Tarhini (2018) and Ciccaglione (2018) used esomeprazole 40 mg bid.…”

mentioning

confidence: 99%

See 1 more Smart Citation

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

2019

View full text Add to dashboard Cite

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.

show abstract

“…In almost 3% of the cases, treatment was discontinued due to AEs. [16][17][18]27,[30][31][32]34,35,37,38,[42][43][44][45]47…”

Section: Safety Of Pylera ®mentioning

confidence: 99%

mentioning

confidence: 99%

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

2019

View full text Add to dashboard Cite

show abstract

“…These results were even slightly higher than expected according to most recent studies that reported eradication rates ranging from 83% to 95% with CQT [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] and from 80% to 95% with BQT. 25,[30][31][32][33][34][35][36][37][38][39] Since eradication rates of different therapies depend on the H pylori resistance pattern to antibiotics, our results are region specific and only applicable to areas with similar resistance rates to main antibiotics.…”

Section: The Addition Of Certain Probiotics (Different Lactobacillus Andmentioning

confidence: 99%

Bismuth‐containing quadruple therapy versus concomitant quadruple therapy as first‐line treatment for Helicobacter Pylori infection in an area of high resistance to clarithromycin: A prospective, cross‐sectional, comparative, open trial

et al. 2018

View full text Add to dashboard Cite

Background Concomitant quadruple (CQT) or bismuth‐containing quadruple therapy (BQT) is recommended as first‐line treatment for Helicobacter pylori infection depending on antibiotic resistance. Aim To compare the efficacy, safety, and compliance of CQT and BQT as first‐line therapy for H. pylori eradication in real clinical practice in an area of high resistance to clarithromycin. Methods A prospective, open, comparative cross‐sectional study including dyspeptic patients >18 years with H. pylori infection and with no previous eradication treatment was performed. CQT (omeprazole 20 mg + clarithromycin 500 mg + amoxicillin 1 g + metronidazole 500 mg, all given twice daily, for 14 days) or BQT (omeprazole 20 mg twice daily + 3 capsules of Pylera® 4 times a day, for 10 days) was prescribed at the discretion of the prescribing physician. Eradication was tested by 13C‐urea breath test. Efficacy was assessed by intention‐to‐treat (ITT) and per‐protocol (PP) analyses. Results One hundred and four consecutive patients were included (64.4% female, age 52.9 years). Fifty patients received CQT and 54 BQT. Eradication rate was similar with both therapies at the PP (CQT 97.9%, 95% CI: 93.9‐100 vs BQT 96.2%, 95% CI: 90.9‐100, P = 0.605) and ITT analyses (CQT 98.0%, 95% CI: 94‐100 vs BQT 94.4%, 95% CI: 88.1‐100, P = 0.346). The rate of adverse events was also similar with CQT (56%) and BQT (46.3%). One patient in each group discontinued the treatment due to significant adverse events. Conclusion The use of CQT and BQT as first‐line treatment against H. pylori is similarly effective and safe strategy in an area of high clarithromycin resistance.

show abstract

“…An Italian study comparing sequential and bismuth‐based therapy did not find that the pattern of bacterial resistance significantly affected eradication rates. Dual resistance to clarithromycin and amoxicillin did, however, lower eradication rates in both treatment strategies . Susceptibility‐based therapy is especially important to guide tailored treatment after failure of standard empiric therapies.…”

Section: Culture‐guided Treatmentmentioning

confidence: 99%

“…Dual resistance to clarithromycin and amoxicillin did, however, lower eradication rates in both treatment strategies. 62 Susceptibility-based therapy is especially important to guide tailored treatment after failure of standard empiric thera-…”

Section: Culture-g U Ided Tre Atmentmentioning

confidence: 99%

Treatment of Helicobacter pylori infection in 2018

et al. 2018

View full text Add to dashboard Cite

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.

show abstract

Pylera and sequential therapy for first-line Helicobacter pylori eradication: a culture-based study in real clinical practice

Abstract: In our country, sequential and bismuth-based quadruple therapy achieved similarly high eradication rates as first-line treatments for H. pylori infection in clinical practice.

Cited by 34 publications

References 21 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

Bismuth‐containing quadruple therapy versus concomitant quadruple therapy as first‐line treatment for Helicobacter Pylori infection in an area of high resistance to clarithromycin: A prospective, cross‐sectional, comparative, open trial

Treatment of Helicobacter pylori infection in 2018

Contact Info

Product

Resources

About