Randomized controlled trial: PPI-based triple therapy containing metronidazole versus clarithromycin as first-line treatment for Helicobacter pylori in adolescents and young adults in Japan

Mabe, Katushiro; Okuda, Masumi; Kikuchi, Shogo; Amagai, Kenji; Yoshimura, Rie; Kato, Mototsugu; Sakamoto, Naoya; Asaka, Masahiro

doi:10.1016/j.jiac.2018.02.013

Cited by 27 publications

(26 citation statements)

References 28 publications

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“…These adverse effects, however, are not metronidazole‐specific; they also appear due to the use of other antibiotics, such as clarithromycin. Regarding the frequency of these adverse effects reported in previous RCTs or observational studies, no statistically significant differences in the frequencies of most of the abovementioned adverse effects were noted between the metronidazole and the clarithromycin groups . Rare adverse effects documented in case reports include encephalopathy and neurotoxicity in adults, but no deaths have been reported associated with the use of metronidazole for H pylori eradication in adults or children.…”

Section: Efficacy and Adverse Effects Of Metronidazole‐containing H Pmentioning

confidence: 78%

“…To date, there have been very limited data collected on the efficacy of metronidazole‐containing eradication therapy either as a first‐line or second‐line regimen in Japanese children and adolescents (Table ). A 2018 randomized controlled trial (RCT) provided long‐awaited evidence that metronidazole can be used as a first‐line regimen for H pylori eradication therapy among adolescents . In that RCT, 43 adolescents were randomly assigned to receive clarithromycin‐containing triple therapy, while 58 adolescents received metronidazole‐containing triple therapy.…”

Section: Efficacy and Adverse Effects Of Metronidazole‐containing H Pmentioning

confidence: 99%

“…A 2018 randomized controlled trial (RCT) provided long-awaited evidence that metronidazole can be used as a firstline regimen for H pylori eradication therapy among adolescents. 14 In that RCT, 43 adolescents were randomly assigned to receive clarithromycin-containing triple therapy, while 58 adolescents re- in the clarithromycin group. That study was the first RCT in Japan that directly compared the eradication rates between metronidazole and clarithromycin, demonstrating the superiority of metronidazole-containing over clarithromycin-containing regimens in the setting of first-line use among adolescents.…”

Section: Effic Ac Y and Adver S E Effec Ts Of Me Tronida Zole-contamentioning

confidence: 99%

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Metronidazole for Helicobacter pylori eradication therapy among children and adolescents in Japan: Overcoming controversies and concerns

et al. 2019

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Background Metronidazole is an antiprotozoal drug used to treat a broad spectrum of infectious diseases, including Helicobacter pylori (H pylori) infections. In Japan, metronidazole is approved for the eradication therapy of H pylori as a second‐line regimen among adults, but it has not yet been approved for use among children and adolescents. Materials and Methods To perform this narrative review, we searched the relevant literature on important events in the history of the use of metronidazole, its mechanisms of action, its efficacy, and the adverse effects reported in clinical trials or cohort studies in Japan. Results At present, metronidazole resistance has not been a serious issue in Japan in large part due to its restricted use. Emerging evidence from randomized controlled trials demonstrates higher eradication rates for metronidazole than for clarithromycin, supporting its use in both first‐line and second‐line eradication therapies. Among the reported adverse effects, there has been lingering concern over the potential carcinogenicity of metronidazole in humans. However, the possibility of an increased cancer risk is not limited to metronidazole; the long‐term use of antibiotics has been linked to increased risk for some site‐specific cancers. However, recent prospective studies have suggested that short‐term exposure to antibiotics is not associated with an increased cancer risk. Conclusion Sensible use of metronidazole backed by research evidence could maximize the benefits associated with H pylori eradication in Japan.

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Section: Efficacy and Adverse Effects Of Metronidazole‐containing H Pmentioning

confidence: 78%

Section: Efficacy and Adverse Effects Of Metronidazole‐containing H Pmentioning

confidence: 99%

Section: Effic Ac Y and Adver S E Effec Ts Of Me Tronida Zole-contamentioning

confidence: 99%

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Metronidazole for Helicobacter pylori eradication therapy among children and adolescents in Japan: Overcoming controversies and concerns

et al. 2019

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“…A randomized controlled trial in Japan where clarithromycin resistance is a growing problem found metronidazole to be superior to clarithromycin as a 7-day first-line regimen in adolescents and young adults, achieving eradication in 98% for metronidazole-based triple therapy compared to just 60% for the clarithromycin-based regimen. 10 By contrast, in Rwanda, in a separate randomized controlled trial, metronidazole-based triple therapy performed poorly with 36% treatment failure compared to 13% for a clarithromycin-based regimen and 18% for a ciprofloxacinbased regimen. 11 A meta-analysis of studies of triple therapy regimens carried out in Turkey of varying durations and combinations were also discouraging both low with eradication rates for 7 days of treatment (57%) and for 14 days of treatment (60%).…”

Section: Triple Ther Apymentioning

confidence: 98%

Review: Treatment of Helicobacter pylori Infection 2019

et al. 2019

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This review summarizes important studies regarding Helicobacter pylori therapy published from May 2018 to May 2019. The main themes that emerge involve studies assessing the efficacy of bismuth‐based regimens. While in recent years the efficacy of bismuth‐based quadruple therapy as a second‐line therapy has been clearly established, there is now substantial evidence that it is the best performing first‐line therapy. Antibiotic resistance was again intensely studied this year, and a clear and dramatic increase in resistance is noted for clarithromycin and levofloxacin; most notably, it may not be possible to support these therapies in most regions of the world much longer without testing. The utility of vonoprazan as an alternative to proton‐pump inhibitor therapy, especially in resistant and difficult to treat groups, has also been considered in greater detail this year, as well as means of supporting and enhancing adherence to therapy. Several studies showed that the diversity of gut microbiota was significantly altered shortly after H pylori eradication. However, the diversity was restored to pre‐treatment state after 2 months in patients treated with triple therapy. More studies are warranted to assess the long‐term changes of gut microbiota after H pylori eradication.

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“…The prevalence of H pylori resistant to antibiotics differs among countries (Table ) and is usually explained by the different exposure to the corresponding antibiotics in each population . First‐line treatment should, therefore, be tailored according to the strain's susceptibility or, if tests are not available, at least according to the regional antibiotic resistance rates of H pylori strains …”

Section: Diagnosismentioning

confidence: 99%

Review: Helicobacter pylori in pediatrics

2019

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Despite a decrease in the prevalence of Helicobacter pylori infection, it still poses a significant health burden worldwide. This review summarizes important pediatric studies on H pylori published from April 2018 to March 2019. Epidemiologic studies have reported different prevalences in different parts of the world and have mainly confirmed traditional risk factors. Several studies on pathophysiology attempted to identify risk markers in childhood for gastric cancer development later in life. One of the most interesting studies evaluated the relationship between eosinophilic esophagitis and H pylori infection; however, an inverse relationship was not confirmed. The high resistance of H pylori and, consequently, low eradication rates, is still a major concern and susceptibility testing before treatment has again been highlighted. Potassium‐competitive acid blockers are promising new acid‐suppressant drugs but their role in H pylori eradication schemes is still to be determined.

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Randomized controlled trial: PPI-based triple therapy containing metronidazole versus clarithromycin as first-line treatment for Helicobacter pylori in adolescents and young adults in Japan

Cited by 27 publications

References 28 publications

Metronidazole for Helicobacter pylori eradication therapy among children and adolescents in Japan: Overcoming controversies and concerns

Metronidazole for Helicobacter pylori eradication therapy among children and adolescents in Japan: Overcoming controversies and concerns

Review: Treatment of Helicobacter pylori Infection 2019

Review: Helicobacter pylori in pediatrics

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