Recurrence of duodenal ulcer and
            <i>Campylobacter pylori</i>
            infection after eradication

Borody, Thomas J.; Cole, P.; Noonan, Suzanne; Morgan, A. G.; Lenne, Jennifer; Hyland, L; Brandl, S; Borody, Edith G.; George, L L

doi:10.5694/j.1326-5377.1989.tb101251.x

Cited by 188 publications

(62 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…When a single antibiotic proved ineffective, dual and triple drug therapies were tried and eventually an effective regimen consisting of bismuth subcitrate, tetracycline and metronidazole was identified by Tom Borody in Australia 12;24;25 . That original study used bismuth subcitrate 120 mg and tetracycline 500 mg both q.i.d.…”

Section: Bismuth Quadruple Therapy For H Pylori Eradicationmentioning

confidence: 99%

How to Effectively Use Bismuth Quadruple Therapy

Graham

Lee

2015

Gastroenterology Clinics of North America

133

174

View full text Add to dashboard Cite

Bismuth triple therapy was the first truly effective Helicobacter pylori eradication therapy. The addition of a proton pump inhibitor largely overcame the problem of metronidazole resistance. Resistance to its being the primary first line therapy have centered on convenience (the large number of tablets required) and side effects causing difficulties with patient adherence. Understanding why the regimen is less successful in some regions remains unexplained in part because of the lack of studies including susceptibility testing. A number of modifications have been proposed such as twice-a-day therapy which addresses both major criticism but the studies with susceptibility testing required to prove its effectiveness in high metronidazole resistance areas are lacking. Most publications lack the data required to understand why they were successful or failed (e.g., detailed resistance and adherence data) and are therefore of little value. We discuss and provide recommendations regarding variations including substitution of doxycycline, amoxicillin, and twice a day therapy. We describe what is known and unknown and provide suggestions regarding what is needed to rationally and effectively use bismuth quadruple therapy. Its primary use is when penicillin cannot be used or when clarithromycin and metronidazole resistance is common. Durations of therapy less than 14 days are not recommended.

show abstract

Section: Bismuth Quadruple Therapy For H Pylori Eradicationmentioning

confidence: 99%

How to Effectively Use Bismuth Quadruple Therapy

Graham

Lee

2015

Gastroenterology Clinics of North America

133

174

View full text Add to dashboard Cite

show abstract

“…The original highly successful therapy for H. pylori eradication was developed by Borody et al in 1989 and consisted of bismuth, metronidazole, and tetracycline [45]. Because of reduced effectiveness in the presence of metronidazole resistance, a PPI was added and the duration of therapy extended which maintained its effectiveness despite metronidazole resistance [17, 46].…”

Section: Bismuth Quadruple Therapymentioning

confidence: 99%

Helicobacter pyloritherapy: a paradigm shift

Graham

Dore

2016

Expert Review of Anti-infective Therapy

103

124

View full text Add to dashboard Cite

SUMMARY Helicobacter pylori (H. Pylori) is a leading cause of gastroduodenal disease, including gastric cancer. H. pylori eradication therapies and their efficacy are summarized. A number of current treatment regimens will reliably yield >90% or 95% cure rates with susceptible strains. None has proven to be superior. We show how to predict the efficacy of a regimen in any population provided one knows the prevalence of antibiotic resistance. As with other infectious diseases, therapy should always be susceptibility-based. Susceptibility testing should be demanded. We provide recommendations for empiric therapies when the only option and describe how to distinguish studies providing misinformation from those providing reliable and interpretable data. When treated as an infectious disease, high H. pylori cure rates are relatively simple to reliably achieve.

show abstract

“…Because of the lack of susceptibility data, an optimal therapy might be defined as one that reliable achieves high cure rates (e.g., ≥90% or greater) irrespective of the presence of antimicrobial resistance. The first reliably effective antimicrobial regimen was a multi-drug combination consisting of bismuth subcitrate, metronidazole and tetracycline (BMT) [8,9]. It was soon recognized that the effectiveness of BMT was diminished in the presence of metronidazole resistance and further studies showed its effectiveness could be at least partially restored by the addition of a proton pump inhibitor (PPI) along with using higher doses of metronidazole and extending the duration [10–13].…”

Section: Introductionmentioning

confidence: 99%

Bismuth-containing quadruple therapy for Helicobacter pylori

Lü¹,

Zhang²,

Graham³

2013

European Journal of Gastroenterology & Hepatology

View full text Add to dashboard Cite

Objective Antimicrobial resistance has continued to undermine many popular anti-Helicobacter pylori therapies. Antibiotic resistance to commonly used anti-H. pylori drugs in China has increased remarkably making China an ideal site to identify regimens that remain effective despite widespread antimicrobial resistance. Bismuth is one of the few antimicrobials to which resistance does not develop. Factors contributing to H. pylori treatment success include host factors (e.g., genetic differences in metabolism of the drugs used), bacterial factors (e.g., susceptibility) and details of the regimen (e.g., doses, dosing interval, dosing in relation of meals, formulation, etc). Methods We reviewed the recent experience in China with bismuth-containing quadruple therapies. The experience consists of 16 studies with 25 arms involving 1,971 patients to identify successful regimens (defined as reliably obtaining 90% or greater eradication per protocol) deserving of further study. Results Despite high rates of resistance to commonly used antimicrobials, several regimens were able to achieve high success. These were characteristically 14 day regimens containing a proton pump inhibitor and either tetracycline and metronidazole or furazolidone and amoxicillin. Conclusions We propose approaches for further development including for optimization and simplification relation to convenience and side effects (e.g., twice rather than three or 4 times daily or administration at the noon and evening meal instead of at breakfast and evening) while maintaining effectiveness ≥ 90%. Studies in China identified regimens that were highly effective despite the high prevalence of resistance to metronidazole, fluoroquinolones, and macrolides. Multicenter randomized studies will be required to confirm which is best.

show abstract

Recurrence of duodenal ulcer and Campylobacter pylori infection after eradication

Cited by 188 publications

References 27 publications

How to Effectively Use Bismuth Quadruple Therapy

How to Effectively Use Bismuth Quadruple Therapy

Helicobacter pyloritherapy: a paradigm shift

Bismuth-containing quadruple therapy for Helicobacter pylori

Contact Info

Product

Resources

About