Searching for an optimal therapy for <i>H pylori</i> eradication: High‐dose proton‐pump inhibitor dual therapy with amoxicillin vs. standard triple therapy for 14 days

Leow, Alex Hwong Ruey; Chang, Jo-Ven; Goh, Khean‐Lee

doi:10.1111/hel.12723

Cited by 15 publications

(27 citation statements)

References 24 publications

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“…Clarithromycin is a key antibiotic that we continue to recommend as first-line therapy. A recently published paper from our centre has shown a high success rate with 2-week STT incorporating clarithromycin which is reflective of the susceptibility of our local strains to clarithromycin ( Hwong-Ruey Leow, Chang & Goh, 2020 ). However, with the rise in resistance rates as shown in this present study, success rates of this therapy will drop in the future.…”

Section: Discussionmentioning

confidence: 99%

Current status ofHelicobacter pyloriresistance to Clarithromycin and Levofloxacin in Malaysia—findings from a molecular based study

Puah

Goh

et al. 2021

PeerJ

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Background Resistance to clarithromycin and levofloxacin in Helicobacter pylori which resulted in treatment failures has become a major challenge for physicians worldwide. The resistance is mainly mediated by mutations in a specific domain of the 23S rRNA, gyrA and gyrB genes for clarithromycin and levofloxacin respectively. Hence in this study, we aimed to investigate the current status of H. pylori resistance in our hospital to these two antibiotics based on the molecular approach. Materials and Methods Gastric biopsy samples were obtained from treatment-naïve patients. Bacterial genomic DNA was extracted using a commercial kit and continued with DNA amplification using polymerase chain reaction (PCR) with specific primers. The PCR amplicons were subjected to sequencing on 23S rRNA gene targeting nucleotide positions at 2,146, 2,147, 2,186 and amino acids at gyrA positions 87 and 91 and gyrB positions 436, 438, 481, 484 to investigate the possible mutations or polymorphisms of genes that lead to clarithromycin and levofloxacin resistance respectively. Results Sixty-one urease-positive gastric biopsy samples were studied. The findings revealed the primary resistance rates to clarithromycin was 14.8% and to levofloxacin was 3.3% in our current scenario based on detection of reported resistance-related mutations of A2147G and D91N in 23S rRNA and gyrA genes, respectively. Interestingly, we found a high rate of silent mutations of the gyrA codon 87Asn (32.8%, 20/61) and two polymorphisms of the gyrB D481E (16.4%, 10/61) and R484K (21.3%, 13/61). The role of these polymorphisms in gyrB remained to be elucidated whether the levels of levofloxacin resistance are related to the position/amino acid. Conclusion The primary resistance rate of H. pylori to clarithromycin has increased compared to the previous report in Malaysia. Therefore, molecular screening could aid and is important for the selection of antibiotics for H. pylori eradication therapies.

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Section: Discussionmentioning

confidence: 99%

Current status ofHelicobacter pyloriresistance to Clarithromycin and Levofloxacin in Malaysia—findings from a molecular based study

Puah

Goh

et al. 2021

PeerJ

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“…Six studies involving H . pylori first‐line therapy encompassed 1999 patients 5‐7,23‐25 . In the ITT analysis, the eradication rate of the DT was significantly higher than that of other regimens (89.8% vs 84.2%, OR: 1.63, 95% CI: 1.02–2.61, p = 0.04).…”

Section: Resultsmentioning

confidence: 98%

“…The current systematic reviews and meta‐analyses showed that PPI‐amoxicillin DT is not superior to other regimens, 16‐20 however, several recent studies have shown that the PPI‐amoxicillin DT administered four‐times daily can obtain a high eradication rate, 5‐7 deeming it as not just a combination of two drugs but also as a method with a pathophysiological basis to achieve satisfactory efficacy. Three main factors have been speculated to affect the efficacy of DT.…”

Section: Discussionmentioning

confidence: 94%

“…In this study, we included a total of nine articles, 5‐7,10,23‐27 comprising 2638 patients, of which 1999 patients received first‐line therapy, and 639 patients received salvage treatment. In the ITT analysis, the H .…”

Section: Resultsmentioning

confidence: 99%

“…pylori to amoxicillin are maintained at a low level 4 . In recent years, proton‐pump inhibitor (PPI) and amoxicillin dual therapy (DT) have gained increasing attention worldwide because of its good eradication efficacy in several studies 5‐7 . Unge et al first used PPI and amoxicillin DT to eradicate H .…”

Section: Introductionmentioning

confidence: 99%

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PPI‐amoxicillin dual therapy four times daily is superior to guidelines recommended regimens in the Helicobacter pylori eradication therapy within Asia: A systematic review and meta‐analysis

Shi

Suo

et al. 2021

Helicobacter

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Background: Systematic reviews suggested that the eradication efficacy of PPIamoxicillin dual therapy is similar to that of other commonly used regimens. However, it might be affected by the medication frequency. Basic and clinical studies have shown that dual therapy administered four-times daily has a reliable pathophysiological basis and could achieve satisfactory efficacy. Therefore, a systematic review of RCTs of dual therapy and other regimens was conducted to clarify whether dual therapy is superior to guidelines recommended regimens. Materials and Methods:The RCTs comparing dual therapy with other regimens were subjected to meta-analysis to evaluate the eradication rate, adverse reactions, and compliance using a random-effects model. Results:Dual therapy administered four-times daily had a higher eradication rate than other regimens (intention-to-treat analysis: 89.7% vs 84.6%, OR: 1.52, 95%CI 1.08-2.14, p = 0.02; per-protocol analysis: 92.6% vs 88.2%, OR: 1.54, 95%CI 1.01-2.34, p = 0.04). In first-line therapy, according to intention-to-treat analysis, the eradication rate of dual therapy was higher than other regimens (89.8% vs 84.2%, OR: 1.63, 95%CI 1.02-2.61, p = 0.04). In per-protocol analysis, dual therapy showed better efficacy than others (92.9% vs 88.3%, OR: 1.68, 95% CI 0.98-2.89, p = 0.06), but not significantly. In salvage treatment, no significant difference was detected. The safety of dual therapy was significantly better than other regimens (19.6% vs 36.7%, p < 0.01), but no difference was observed in compliance (p = 0.58). Conclusion:PPI-amoxicillin dual therapy administered four-times daily has better efficacy and safety in H. pylori eradication than current guidelines recommended regimens, especially in first-line therapy, and mainly in Asia.

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A Malaysian consensus report on the diagnosis and treatment of Helicobacter pylori infection

et al. 2023

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Helicobacter pylori is one of the most common chronic bacterial infections in humans and responsible for 90% of duodenal ulcers and 70-90% of gastric ulcers. Despite this, many misconceptions regarding the appropriate diagnostic method and treatment strategies still exist in the Malaysian clinical practice. Under the initiative of the steering committee, an expert panel consisting of nine key opinion leaders in the field of gastroenterology convened to develop a set of consensus statements that are relevant to the Malaysian healthcare practice. The panel members reviewed the current evidence on the management of H. pylori infection, focusing on the best practices that are relevant to the Malaysian population based on clinical experience and published clinical evidence. Using the modified Delphi method, the panel achieved consensus in three areas of H. pylori infection management: indications for testing, diagnosis, and treatment. The panel proposed a set of 19 consensus statements, which were synthesized via two rounds of blinded voting and group discussions. The recommendations provided are relevant to the Malaysian population and can be used as a guide by physicians across various healthcare settings to facilitate appropriate diagnostic testing and treatment of H. pylori infection.

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Searching for an optimal therapy for H pylori eradication: High‐dose proton‐pump inhibitor dual therapy with amoxicillin vs. standard triple therapy for 14 days

Cited by 15 publications

References 24 publications

Current status ofHelicobacter pyloriresistance to Clarithromycin and Levofloxacin in Malaysia—findings from a molecular based study

Current status ofHelicobacter pyloriresistance to Clarithromycin and Levofloxacin in Malaysia—findings from a molecular based study

PPI‐amoxicillin dual therapy four times daily is superior to guidelines recommended regimens in the Helicobacter pylori eradication therapy within Asia: A systematic review and meta‐analysis

A Malaysian consensus report on the diagnosis and treatment of Helicobacter pylori infection

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