Review article: the treatment of refractory <i>Helicobacter pylori</i> infection

Mégraud, Françis; Lamouliatte, H

doi:10.1046/j.1365-2036.2003.01592.x

Cited by 188 publications

(182 citation statements)

References 86 publications

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“…Antibiotic resistance is a potential problem in some individuals, however (70). The transmission of antibiotic resistance often occurs vertically from the organism in which the mutation appears, and an increase in resistance can be observed over time (71).…”

Section: Helicobacter Pylorimentioning

confidence: 99%

Multiple Infections and Cancer: Implications in Epidemiology

Vedham

Divi

Starks

et al. 2014

Technol Cancer Res Treat

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Approximately 18% of the global cancer burden has been attributed to infectious agents, with estimates ranging from 7% in developed countries to about 22% in developing countries.Chronic infections caused by the hepatitis B and C viruses, human papilloma viruses (HPV), and Helicobacter pylori (H. pylori) are reported to be responsible for approximately 15% of all human cancers. Interestingly, although many of the infectious agents that have been associated with cancer-such as HPV, Epstein-Barr virus (EBV), and H. pylori-are highly prevalent in the world, most infected individuals do not develop cancer but remain lifelong carriers. Malignancies associated with infectious agents may result from prolonged latency as a result of chronic infections. Pathogenic infections are necessary but are not sufficient for cancer initiation or progression. Cancer initiation may require additional cofactors, including secondary infections. Therefore, in patients with chronic infection with one agent, secondary co-infection with another agent may serve as an important co-factor that may cause cancer initiation and progression. Additionally, opportunistic co-infections could significantly inhibit response to cancer treatment and increase cancer mortality. Co-infections are relatively common in areas with a high prevalence of infectious agents, especially in developing countries. These co-infections can cause an imbalance in the host immune system by affecting persistence of and susceptibility to malignant infections. Several articles have been published that focus on infectious agents and cancer. In this article, we discuss the role of infectious agents in malignancies, highlight the role of multiple/co-infections in cancer etiology, and review implications for cancer epidemiology.

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Section: Helicobacter Pylorimentioning

confidence: 99%

Multiple Infections and Cancer: Implications in Epidemiology

Vedham

Divi

Starks

et al. 2014

Technol Cancer Res Treat

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“…[22] Nevertheless, it is recommended that those prescribing H pylori eradication therapies continually assess their success rate and adjust the relevant local practices and policies in line with the results and local bacterial resistance patterns. Thus, it would be recommendable that culture should be routinely performed after eradication failure in some specialized centers with special interest in H pylori research and treatment, with the intention to study the incidence of resistances after failures and also to evaluate the influence of such resistances on the efficacy of rescue regimens [158] . Data coming from this experience on H pylori resistance will be used as a reference for the corresponding population.…”

Section: Is It Necessary To Performmentioning

confidence: 99%

“…Data coming from this experience on H pylori resistance will be used as a reference for the corresponding population. This preventive approach has been recommended to avoid an increase in refractory H pylori infection in the future [158] .…”

Section: Is It Necessary To Performmentioning

confidence: 99%

“…This antibiotic has demonstrated a high antimicrobial activity against H pylori if given as a single drug [175] , and the majority of first-line furazolidone-based combination therapies revealed eradication rates above 80% [92] . Primary resistance to furazolidone is virtually absent [158,176,177] , and its potential to develop resistance is as low as for bismuth compounds or amoxicillin [178] . Moreover, this drug has no cross-resistance potential to metronidazole [176] .…”

Section: Furazolidone-based Rescue Regimensmentioning

confidence: 99%

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“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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“…La combinación de metronidazol con otros antibióticos se utiliza ampliamente en el tratamiento estándar contra la infección por H. pylori y otras infecciones bacterianas anaerobias (32)(33)(34)(35)(36)(37). Sin embargo, la resistencia de la bacteria al metronidazol es una de las causas del fracaso del tratamiento de dolencias gástricas (7).…”

Section: Discussionunclassified

Mutations frequency of RdxA a nitroreductase Helicobacter pylori for activation of metronidazole: a population study in the Department of Cauca

et al. 2017

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Introducción. La resistencia a metronidazol es un factor clave asociado con el fracaso del tratamiento contra la infección por Helicobacter pylori. Aunque la resistencia se asocia principalmente con mutaciones en la nitroreductasa RdxA, estudios en esta proteína de H. pylori en Popayán – Colombia son aún incipientes. Objetivo. Evaluar la frecuencia de mutaciones en la nitroreductasa RdxA en una población de pacientes con enfermedad gastroduodenal H. pylori positivo.Materiales y métodos. El ADN de 170 biopsias gástricas fue amplificado por PCR para detectar las mutaciones en la nitroreductasa RdxA. Se realizó análisis de las secuencias traducidas a aminoácidos y se comparó con la cepa de referencia 26695.Resultados. La frecuencia de mutaciones en la nitroreductasa RdxA en la población de estudio fue 78%. Su distribución más frecuente, fue encontrada en las posiciones: D59N (153 muestras); R131K (101 muestras); R90K (97 muestras); A118T (42 muestras), I160F (32 muestras), H97T (26 muestras) y en los codones de parada Q50*; D59*; E75*; C159*; I160* (5, 1, 3, 10 y 6 muestra) respectivamente. El genotipo de virulencia más frecuente fue vacAs1/m1 cagA negativo, (48,6 %).Conclusiones. La alta frecuencia de mutaciones en la nitroreductasa RdxA en aislamientos de H. pylori en la ciudad de Popayán – Colombia indica que terapias empíricas con metronidazol podrían no ser una opción válida para la erradicación de H. pylori en pacientes de la población estudiada del departamento del Cauca.

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Review article: the treatment of refractory Helicobacter pylori infection

Cited by 188 publications

References 86 publications

Multiple Infections and Cancer: Implications in Epidemiology

Multiple Infections and Cancer: Implications in Epidemiology

“Rescue” regimens after Helicobacter pylori treatment failure

Mutations frequency of RdxA a nitroreductase Helicobacter pylori for activation of metronidazole: a population study in the Department of Cauca

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