Quadruple therapy containing amoxicillin and tetracycline is an effective regimen to rescue failed triple therapy by overcoming the antimicrobial resistance of <i>Helicobacter pylori</i>

Chi, Chih-Hsien; Lin, Ching-Nan; Sheu, Bor–Shyang; Yang, Hsiao Bai; Huang, Angus; Wu, Jiunn-Jong

doi:10.1046/j.1365-2036.2003.01653.x

Cited by 56 publications

(72 citation statements)

References 25 publications

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“…Therefore, successful eradication of H. pylori is a crucial component in the treatment of gastroenterologic and hematologic diseases including chronic gastritis, peptic ulcers, gastric adenocarcinoma, gastric-mucosa-associated lymphoid tissue lymphoma, sideropenic anemia, and primary immune thrombocytopenia. Nevertheless, H. pylori eradication rate of first-line triple regimen and rescue regimen with various patterns of antibiotic resistance are from 55 to 90 % and 70 to 90 % throughout the world (30)(31)(32). Furthermore, because of the use of antibiotics in eradication therapy, they kill not only H. pylori, but also the normal flora in the stomach, equivalent to further damage of the gastric micro-ecological environment which leads to the bacterial superinfection and H. pylori infection recurrence.…”

Section: Discussionmentioning

confidence: 99%

Lactobacillus -containing probiotic supplementation increases Helicobacter pylori eradication rate: evidence from a meta-analysis

Zheng¹,

Lin²,

Mei³

2013

Rev. esp. enferm. dig.

102

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Background: Helicobacter pylori infection is recognized as a major contributory factor to many diseases, but recommended eradication therapies demonstrated unsatisfactory eradication rates. Currently, some studies suggested that lactobacillus species have an inhibitory action on Helicobacter pylori both in vitro and in vivo.Objective: this meta-analysis broadly examined the efficacy of eradication regimens supplemented with lactobacillus-containing probiotic on eradication rates and side effects.Methods: eligible articles were identified by comprehensive searches. Statistical analysis was performed with Review Manager 5.2. Outcomes were finally evaluated according to GRADE system.Results: nine randomized controlled trials of high-quality met eligible criteria. Risk ratio of eradication was available for 1,163 patients. Lactobacillus-containing probiotics significantly increased the eradication rate compared with the control group based upon intention-to-treat analysis [RR = 1.14; 95 %CI (1.06-1.22); number needed to treat (NNT) = 10] by the fixed effect model without significant publication bias, but no significant reduction associated with overall side effects was observed [RR = 0.88;]. In the subgroup analysis, eradication rates raised significantly by 17 % in lactobacillus administrated alone group [RR = 1.25; 95 %CI (1.13-1.37); NNT = 6]. In multistrain probiotics group, eradication rates enhanced only 2.8 % [RR = 1.04; 95 %CI (0.94-1.14)]. It also showed that lactobacillus-containing probiotics improved the eradication rates, respectively, both in adults [RR = 1.12; Conclusions: Lactobacillus-containing probiotic as an adjunct is effective to eradication therapy, while side effects caused by eradication treatment may not decrease. Furthermore, lactobacillus administrated alone will distinctly benefit eradication therapy.

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Section: Discussionmentioning

confidence: 99%

Lactobacillus -containing probiotic supplementation increases Helicobacter pylori eradication rate: evidence from a meta-analysis

Zheng¹,

Lin²,

Mei³

2013

Rev. esp. enferm. dig.

102

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“…Recent publications provide data on the successful eradication of H. pylori by the use of tetracycline-based treatments (1,2,6). The more frequent use of tetracyclines for the eradication of H. pylori in Germany is likely to be associated with increasing numbers of tetracycline-resistant H. pylori strains in this country in the future.…”

Section: Discussionmentioning

confidence: 99%

“…Increasing rates of resistance to the first-line antibiotic drugs (e.g., clarithromycin) are compromising the eradication of H. pylori and result in therapy failures (8). Thus, alternative treatments that include tetracyclines are recommended (1,2,14).…”

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confidence: 99%

Real-Time PCR Screening for 16S rRNA Mutations Associated with Resistance to Tetracycline in Helicobacter pylori

Glocker

Berning

Gerrits

et al. 2005

Antimicrob Agents Chemother

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The effectiveness of recommended first-line therapies for Helicobacter pylori infections is decreasing due to the occurrence of resistance to metronidazole and/or clarithromycin. Quadruple therapies, which include tetracycline and a bismuth salt, are useful alternative regimens. However, resistance to tetracycline, mainly caused by mutations in the 16S rRNA genes (rrnA and rrnB) affecting nucleotides 926 to 928, are already emerging and can impair the efficacies of such second-line regimens. Here, we describe a novel real-time PCR for the detection of 16S rRNA gene mutations associated with tetracycline resistance. Our PCR method was able to distinguish between wild-type strains and resistant strains exhibiting single-, double, or triple-base-pair mutations. The method was applicable both to DNA extracted from pure cultures and to DNA extracted from fresh or frozen H. pylori-infected gastric biopsy samples. We therefore conclude that this real-time PCR is an excellent method for determination of H. pylori tetracycline resistance even when live bacteria are no longer available.Helicobacter pylori infection is chronic in nature, causes gastritis, and increases the risk of development of peptic ulcer disease, mucosa-associated lymphoid tissue lymphoma, and gastric cancer (for reviews, see references 13, 18, and 20). Increasing rates of resistance to the first-line antibiotic drugs (e.g., clarithromycin) are compromising the eradication of H. pylori and result in therapy failures (8). Thus, alternative treatments that include tetracyclines are recommended (1, 2, 14).Tetracyclines are bacteriostatic drugs which exert their antimicrobial effects by affecting the 30S subunit of the ribosome and block the binding of aminoacyl-tRNA, resulting in impaired protein biosynthesis (3,22). The resistance of H. pylori to tetracyclines is reported to be caused by mutations in the 16S rRNA. H. pylori isolates exhibiting AGA 926-928 3 TTC triple-base-pair mutations (4,5,22) show MICs higher than 4 mg/liter and probably represent the clinically most relevant strains, whereas single-or double-base-pair mutations were, rather, associated with MICs between 1 mg/liter and 4 mg/liter (3, 5).The susceptibility of H. pylori to tetracycline is routinely examined by agar diffusion (Etest) or agar dilution tests, which are accepted to be the "gold standards" (10). These methods are slow and time-consuming, and they sometimes fail due to a lack of growth of the infecting H. pylori strain or due to overgrowth with contaminating bacteria.It has already been shown that real-time PCR assays are elegant methods for prediction of resistance to clarithromycin (15, 16) or ciprofloxacin (7) in H. pylori. The major advantage of this technique over classical microbiological resistance testing is not in its enhanced speed and standardization but is mostly in the option to test for resistance in clinical specimens that no longer contain live bacteria.In this study, a real-time PCR for the detection of 16S rRNA gene mutations associated with tetracycline re...

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“…This study suggests that, although the "old-fashioned" dual combination of omeprazole plus amoxicillin is generally considered quite ineffective as a first-line regimen, it may be associated with relatively good results if prescribed at high doses, even for H pylori resistant to both metronidazole and clarithromycin, in patients who experienced previous treatment failures. Another possibility to avoid retreatment with clarithromycin or metronidazole is to prescribe a quadruple combination of PPI, bismuth, tetracycline and amoxicillin (instead of metronidazole), which has been used by some authors with favorable results [161] . Nevertheless, this regimen has been tested only as second-line (and not third-line) therapy, and only after failure of PPI-clarithromycin-amoxicillin (and not after metronidazole-based therapy), emphasizing that the experience should be extended to patients with two previous eradication failures containing both clarithromycin and metronidazole.…”

Section: Amoxicillin ± Tetracycline-based Regimensmentioning

confidence: 99%

“Rescue” regimens after Helicobacter pylori treatment failure

Gisbert¹

2008

WJG

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Helicobacter pylori (H pylori ) infection is the main cause of gastritis, gastroduodenal ulcer disease, and gastric cancer. After more than 20 years of experience in H pylori treatment, in my opinion, the ideal regimen to treat this infection is still to be found. Currently, apart from having to know first-line eradication regimens well, we must also be prepared to face treatment failures. Therefore, in designing a treatment strategy we should not focus on the results of primary therapy alone, but also on the final (overall) eradication rate. The choice of a "rescue" treatment depends on which treatment is used initially. If a clarithromycinbased regimen was used initially, a subsequent metronidazole-based treatment (quadruple therapy) may be used afterwards, and then a levofloxacinbased combination would be a third "rescue" option. Alternatively, it has recently been suggested that levofloxacin-based rescue therapy constitutes an encouraging second-line strategy, representing an alternative to quadruple therapy in patients with previous PPI-clarithromycin-amoxicillin failure, with the advantage of efficacy, simplicity and safety. In this case, a quadruple regimen may be reserved as a third-line rescue option. Finally, rifabutin-based rescue therapy constitutes an encouraging empirical fourthline strategy after multiple previous eradication failures with key antibiotics such as amoxicillin, clarithromycin, metronidazole, tetracycline, and levofloxacin. Even after two consecutive failures, several studies have demonstrated that H pylori eradication can finally be achieved in almost all patients if several rescue therapies are consecutively given. Therefore, the attitude in H pylori eradication therapy failure, even after two or more unsuccessful attempts, should be to fight and not to surrender.

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Quadruple therapy containing amoxicillin and tetracycline is an effective regimen to rescue failed triple therapy by overcoming the antimicrobial resistance of Helicobacter pylori

Cited by 56 publications

References 25 publications

Lactobacillus -containing probiotic supplementation increases Helicobacter pylori eradication rate: evidence from a meta-analysis

Lactobacillus -containing probiotic supplementation increases Helicobacter pylori eradication rate: evidence from a meta-analysis

Real-Time PCR Screening for 16S rRNA Mutations Associated with Resistance to Tetracycline in Helicobacter pylori

“Rescue” regimens after Helicobacter pylori treatment failure

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