Randomised clinical trial: the efficacy of a 10-day sequential therapy vs. a 14-day standard proton pump inhibitor-based triple therapy for Helicobacter pylori in Korea

Kim, Y. S.; Kim, S. J.; Yoon, Jin‐Kook; Suk, Ki Tae; Kim, J. B.; Kim, Dong Joon; Min, Hyun-Jun; Park, S. H.; Shin, Woon Geon; Kim, K. H.; Kim, H. Y.; Baik, Gwang Ho

doi:10.1111/j.1365-2036.2011.04843.x

Cited by 63 publications

(42 citation statements)

References 45 publications

(60 reference statements)

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“…Mycobacterium tuberculosis is, in some sense, treated in this way [42] but it might also be possible that other pathogens could be treated successfully with regimens that change through time, but such sequential regimens are not common. There is clinical evidence to show that sequential treatments of Helicobacter pylori can outperform combination treatments at the same dose [43,44], although not all trials have been equally successful [45].…”

Section: Resultsmentioning

confidence: 99%

Testing the optimality properties of a dual antibiotic treatment in a two-locus, two-allele model

Peña‐Miller

Fuentes-Hernández

Reding

et al. 2014

J. R. Soc. Interface.

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Mathematically speaking, it is self-evident that the optimal control of complex, dynamical systems with many interacting components cannot be achieved with 'non-responsive' control strategies that are constant through time. Although there are notable exceptions, this is usually how we design treatments with antimicrobial drugs when we give the same dose and the same antibiotic combination each day. Here, we use a frequency-and densitydependent pharmacogenetics mathematical model based on a standard, two-locus, two-allele representation of how bacteria resist antibiotics to probe the question of whether optimal antibiotic treatments might, in fact, be constant through time. The model describes the ecological and evolutionary dynamics of different sub-populations of the bacterium Escherichia coli that compete for a single limiting resource in a two-drug environment. We use in vitro evolutionary experiments to calibrate and test the model and show that antibiotic environments can support dynamically changing and heterogeneous population structures. We then demonstrate, theoretically and empirically, that the best treatment strategies should adapt through time and constant strategies are not optimal.

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Section: Resultsmentioning

confidence: 99%

Testing the optimality properties of a dual antibiotic treatment in a two-locus, two-allele model

Peña‐Miller

Fuentes-Hernández

Reding

et al. 2014

J. R. Soc. Interface.

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show abstract

“…A dedicated study of sequential therapy as a second-line regime was also carried out in Taiwan and revealed excellent eradication rates of 95.1% [10]. In Korea, a study compared the eradication rate of the 10-day sequential therapy with that of the 14-day standard therapy and found a significantly higher rate of eradication in the sequential group (92.6 vs 85%) with no difference in adverse events [11]. Two other studies from Korea compared sequential therapy to a 7-day standard regime and also showed superior eradication in favor of sequential therapy [12,13].…”

Section: Triple Therapymentioning

confidence: 99%

Treatment of Helicobacter pylori infection 2012

et al. 2012

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Helicobacter pylori resistance rates to antibiotics vary in different countries and even in different regions of the same country. Choice of treatment is strongly dependent on antibiotic resistance rates. In some countries, triple therapy with a proton-pump inhibitor, amoxicillin, and clarithromycin is still the best option, but eradication results fall short of what would be desired (90-95%) in countries with clarithromycin resistance >20%, bismuth-containing quadruple therapy, or nonbismuth sequential or concomitant therapies may then be the preferred option. Newer antibiotic regimens are awaited. Vaccination would be the best option, especially for developing countries, but little progress has been made in designing a vaccine.A considerable amount of work has been conducted over the last year assessing many issues around Helicobacter pylori eradication therapy. These focussed primarily on assessing the efficacy of current standard triple therapy and exploring new first-line treatments. There was also progress in investigating antibiotic resistance rates, and the rescue therapies required to deal with ensuing treatment failures. There has also been an evolution in the use of adjunctive therapies. This article will address the published literature over the last year pertaining to these topics. Triple TherapyNumerous studies over the last year have assessed the efficacy of standard triple therapy with amoxicillin, clarithromycin, and a proton-pump inhibitor for the eradication of H. pylori, which have been perceived to be in decline in recent years. One such study looked at cure rates reported in all published literature from Spain between 1997 and 2008 and found that while cure rates have in fact been stable over that period, they remain inadequate with a mean cure rate of 80% by intention-to-treat and 83% by per-protocol [1]. Similar results were obtained from a multicenter study in Japan that revealed an eradication rate of 80.7% with an incidence of adverse drug reactions of 4.4% [2]. Other studies have looked at whether the efficacy of triple therapy can be improved by prolonging the course of therapy. In China, a study of shorter regimens showed eradication rates of 76, 89, and 91% for 3-day, 5-day, and 7-day regimens, respectively [3]. Increasing efficacy by prolongation of therapy was also noted in Greek patients, with eradication rates of 74.5% for 7 days, 80.6% for 10 days, and 90.2% for 14 days of therapy [4]. Another study showed that efficacy could be maintained when lower doses of medications were given, which reduced costs and side effects with cure rates of 77.2% for 10 mg rabeprazole, 500 mg amoxicillin, and 250 mg clarithromycin vs 78.9% for the standard 20 mg, 1 g, and 500 mg doses of these drugs [5].Regardless of the type of therapy used, study from Canada showed widespread failure to comply with test and treat in up to 10% of cases and a failure to confirm eradication in 32% [6]. This illustrates that efficacious first-line therapy will always depend on adherence to guidelines by phy...

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“…Letter: the ethics of using inferior regimens in H. pylori randomised trials -invited comment SIRS, We read with great interest the letter from Professor Graham and Professor Fischbach 1 on the study by Kim et al 2 We feel that this study adds to the body of literature available on sequential therapy and is to be welcomed. Certainly, the eradication rates in the published literature in Korea and elsewhere for sequential therapy have been encouraging.…”

mentioning

confidence: 92%

“…We have recently assessed the efficacy of this regimen through an epidemiological analysis of all published Spanish trials. 2 Unexpectedly, the pooled eradication rates revealed a relatively constant rate (80%) over the years ( Figure 1). Therefore, although a decrease in the triple therapy effectiveness has been suggested in recent years, cure rates with this regimen did not change in Spain between 1997 and 2008.…”

mentioning

confidence: 99%

Letter: the ethics of using inferior regimens in H. pylori randomised trials – invited comment

O’Connor

O’Moráin

2012

Aliment Pharmacol Ther

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Randomised clinical trial: the efficacy of a 10-day sequential therapy vs. a 14-day standard proton pump inhibitor-based triple therapy for Helicobacter pylori in Korea

Abstract: SUMMARY BackgroundThe eradication rates of Helicobacter pylori (H. pylori) using a proton pump inhibitor (PPI)-based triple therapy have declined due to antibiotic resistance worldwide.

Cited by 63 publications

References 45 publications

Testing the optimality properties of a dual antibiotic treatment in a two-locus, two-allele model

Testing the optimality properties of a dual antibiotic treatment in a two-locus, two-allele model

Treatment of Helicobacter pylori infection 2012

Letter: the ethics of using inferior regimens in H. pylori randomised trials – invited comment

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