Quadruple Therapy Is Effective for Eradicating <i>Helicobacter pylori</i> After Failure of Triple Proton‐Pump Inhibitor–Based Therapy: A Detailed, Prospective Analysis of 21 Consecutive Cases

Gomollón, Fernando; Ducóns, Julio; Ferrero, Miguel Pérez; Cabezudo, J. García; Guirao, R.; Simón, Miguel Ángel; Montoro, Miguel

doi:10.1046/j.1523-5378.1999.99307.x

Cited by 68 publications

(68 citation statements)

References 11 publications

(13 reference statements)

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“…In H. pylori eradication therapy, it directly causes bacterial lysis and reduces bacterial density, which in turn increases the therapeutic effects of the antibiotics [34] . Bismuth is also known to reduce bacterial tolerance to eradication therapy by not inducing development of antibiotic resistance [35][36][37] . While the adverse event rate in the 14-d bismuthbased quadruple therapy group in the present study was higher than that of the 7-d therapy group, the difference was not statistically significant.…”

Section: Adverse Events and Compliancementioning

confidence: 99%

Fourteen-vsseven-day bismuth-based quadruple therapy for second-lineHelicobacter pylorieradication

Hwang

Lee

et al. 2015

WJG

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AIM:To compare the efficacy of 14-and 7-d bismuthbased quadruple therapies as second-line eradication treatment for Helicobacter pylori (H. pylori ) infection. METHODS:Between 2004 and 2014, the medical records of 790 patients who had experienced failure of first-line proton pump inhibitor (PPI)-based eradication therapy and were then treated with bismuth-based quadruple therapy were retrospectively reviewed. Those who received bismuth-based quadruple therapy [PPI, bismuth, metronidazole, and tetracycline (PBMT)] for either 7 d or 14 d were assigned to a PBMT-7 group (n = 543) or a PBMT-14 group (n = 247), respectively. The eradication rates for both groups were determined by intention-to-treat (ITT) and per-protocol (PP) analyses. ITT analysis compared the treatment groups as originally allocated while the PP analysis including only those patients who had completed the treatment as originally allocated. Successful eradication therapy for H. pylori infection was defined as a negative 13 C-urea breath test 4 wk after the end of eradication treatment. RESULTS:The overall ITT eradication rate was 69.1% (546/790). Final ITT eradication rates were 67.4% (366/543; 95%CI: 63.1%-71.7%) in the PBMT-7 group and 72.8% (180/247; 95%CI: 67.4%-78.2%) in the PBMT-14 group (P = 0.028). The overall PP eradication rate was 80.0% (546/682), and the final PP eradication rates were 78.2% (366/468; 95%CI: 72.1%-84.0%) in the PBMT-7 group and 84.1% (180/214; 95%CI: 76.8%-90.8%) in the PBMT-14 group (P = 0.009). The H. pylori eradication rates in the PBMT-14 group were Retrospective Study ORIGINAL ARTICLEsignificantly higher than in the PBMT-7 group according to both ITT (P = 0.028) and PP analysis (P = 0.009). Compliance was similar in both groups (PBMT-7 group: 97.9%; PBMT-14 group: 96.4%). Adverse event rates were 10.7% (51/478) and 17.1% (38/222) in the PBMT-7 and PBMT-14 groups, respectively (P = 0.487). CONCLUSION:

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Section: Adverse Events and Compliancementioning

confidence: 99%

Fourteen-vsseven-day bismuth-based quadruple therapy for second-lineHelicobacter pylorieradication

Hwang

Lee

et al. 2015

WJG

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“…The recommended treatment is the 'classic' quadruple therapy which reaches an eradication rate of 75-95% [9,[69][70][71][72][73] . However, a simpler PPI triple therapy with amoxicillinmetronidazole can achieve high success rates.…”

Section: Treatment Options For Nonresponders To First-line Treatment mentioning

confidence: 99%

‘Rescue’ Therapies for the Management of <i>Helicobacter pylori </i>Infection

Mario¹,

Cavallaro²,

Scarpignato

2006

Dig Dis

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Helicobacter pylori infection is the main cause of gastritis, gastroduodenal ulcer and gastric cancer and should be considered as a major public health issue. According to several international guidelines, first-line therapy for treating H. pylori infection consists of proton pump inhibitor (PPI) or ranitidine bismuth citrate (RBC) with any two antibiotics of amoxicillin, clarithromycin or metronidazole given for 7–14 days. However, even with the recommended treatment regimens, approximately 20% of patients will fail to obtain H. pylori eradication. The proportion of patients with first-line H. pylori therapy failure may be higher in clinical practice and it may increase thanks to diffusion of H. pylori treatment. The recommended second-line therapy is the quadruple regimen composed by tetracycline, metronidazole, bismuth salts and a PPI. However, the efficacy of this regimen is limited by poor patient’s compliance due to its side effects, number of tablets per day, and long duration. Moreover, bismuth and metronidazole are not available in all countries. Alternatively, a longer-lasting (i.e. 10–14 days) PPI or RBC triple therapy with two antibiotics has generally been used. In an empirical strategy, the choice of second line depends on the treatment initially used. If a clarithromycin-based regimen was administered in first line, a quadruple regimen or PPI (or RBC) triple therapy with metronidazole and amoxicillin (or tetracycline) should be suggested as a second line. In case of second-line treatment failure, the patient should be evaluated by a case-by-case approach. A susceptibility-guided strategy, if available, is recommended in order to choose the best third-line treatment. Culture can reveal the presence of H. pylori-sensitive strains to clarithromycin (the best effective) or other antimicrobials (such as amoxicillin, metronidazole and tetracycline). Conversely, in an empirical strategy, a third-line not yet used therapy, can reach a high success rate. PPI or RBC, amoxicillin and a new antimicrobial (e.g. rifabutin, levofloxacin or furazolidone) could be used. Several studies have obtained relatively good results with triple therapy combining PPI, rifabutin, and amoxicillin, although a reversible myelotoxicity as leukopenia and thrombocytopenia has been described. Preliminary good results were also achieved with triples PPI regimens combining levofloxacin and amoxicillin without important adverse effects. Furazolidone has also shown efficacy for H. pylori eradication, although untoward reactions could limit its use, especially when high doses are employed. Finally, in more than one H. pylori treatment failure, non-antimicrobial add-on medications (such as lactoferrin, probiotics and others) could be used with the aim either to improve the eradication rate or to minimize side effects.

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“…quadruple therapy after standard triple therapy (amoxicillin, clarithromycin and PPI) with discordant results (57-95%) [97][98][99][100][101][102][103][104][105][106]; Table (3). One of the most frequent criticism to such scheme is a supposed low compliance due both to the high incidence of side effects and to the high number of pills for day.…”

Section: Sequential Treatmentmentioning

confidence: 99%

Treatment of H. pylori Infection: A Review

Candelli

Nista²,

Carloni³

et al. 2005

CMC

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Helicobacter pylori infection has been indicated as the main pathogenic factor in the development of chronic gastritis, peptic ulcer disease, and gastric malignancies. Although the vast majority of infected subjects do not carry but a mild, asymptomatic gastritis, still there are some cases in which the eradication of the infection appears mandatory. This review addresses current anti-Helicobacter regimens and pharmacological resources, and highlights the pros and cons of each of them, according to the most recent and reliable clinical trials. Also, basic recommendations are given, regarding treatment choice in the event of the failure of a first or second line eradicating strategy, and about the implementation of standard regimens with newer antibacterial devices as probiotics.

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Quadruple Therapy Is Effective for Eradicating Helicobacter pylori After Failure of Triple Proton‐Pump Inhibitor–Based Therapy: A Detailed, Prospective Analysis of 21 Consecutive Cases

Abstract: Quadruple therapy obtains a high eradication rate even in patients with clarithromycin- and metronidazole-resistant strains. Further randomized and controlled studies are warranted and are urgently needed.

Cited by 68 publications

References 11 publications

Fourteen-vsseven-day bismuth-based quadruple therapy for second-lineHelicobacter pylorieradication

Fourteen-vsseven-day bismuth-based quadruple therapy for second-lineHelicobacter pylorieradication

‘Rescue’ Therapies for the Management of <i>Helicobacter pylori </i>Infection

Treatment of H. pylori Infection: A Review

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