Sequential versus concomitant therapy for treatment of Helicobacter pylori infection: an updated systematic review and meta-analysis

Wang, Youhua; Zhao, Rulin; Wang, Ben; Qi, Zhao; Li, Zhen; Zhuge, Liya; Yin, Wenzhu; Xie, Yong

doi:10.1007/s00228-017-2347-7

Cited by 27 publications

(25 citation statements)

References 56 publications

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“…A sub-analysis linking outcomes with antibiotic resistance showed that the concomitant regimen performed significantly better in metronidazole-resistant strains [129]. This finding was also confirmed by a recent updated systematic review and metaanalysis comparing sequential vs. concomitant regimens [140]. In addition, in one RCT, an optimized 14-day sequential regimen containing a high dose of a second-generation PPI (esomeprazole 40 mg bid) achieved high eradication rates in both per-protocol (93.9%) and intention-to-treat (91.3%) analyses in a population that included about 20% clarithromycin resistance [141].…”

Section: Recommendation Grade: A; Evidence Level: 1b; Agreement Levelmentioning

confidence: 62%

Hellenic consensus on Helicobacter pylori infection

Georgopoulos

Michopoulos

Rokkas³

et al. 2020

aog

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The Hellenic Society of Gastroenterology recently organized the "Hellenic consensus on Helicobacter pylori (H. pylori) infection". The aim of this publication is to report the guidelines in order to aid the national gastroenterology community in the management of H. pylori infection. Forty-one delegates from all Greek regions, including gastroenterologists, pathologists, clinical microbiologists, epidemiologists and basic scientists, were invited to this meeting. The participants were allocated to 1 of the 4 main topics of the meeting: i.e., H. pylori diagnosis and association with diseases; H. pylori and gastric cancer; H. pylori and extragastric associated disorders; and H. pylori treatment. The results of each subgroup were submitted to a final consensus vote that included all participants. Relevant data based on international and Greek publications were presented, and the quality of evidence, strength of recommendation, and level of consensus were graded. The cutoff level of 70% was considered as acceptance for the final statement. It is hoped that the recommendations and conclusions of this report will guide Greek doctors in their daily practice concerning the management of H. pylori infection.

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Section: Recommendation Grade: A; Evidence Level: 1b; Agreement Levelmentioning

confidence: 62%

Hellenic consensus on Helicobacter pylori infection

Georgopoulos

Michopoulos

Rokkas³

et al. 2020

aog

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“…In this review, the efficacy of concomitant therapy was found to be duration dependent, with 10‐day concomitant therapy being the most efficacious therapy and superior to 10‐day sequential therapy. Concomitant therapy also showed superior efficacy for metronidazole‐resistant strains and metronidazole plus clarithromycin‐resistant strains . A study from Israel suggested better compliance and fewer adverse effects with sequential treatment when used as a second‐line regimen, which they found noninferior to bismuth‐based quadruple therapy …”

Section: Sequential and Concomitant Therapymentioning

confidence: 99%

“…Concomitant therapy also showed superior efficacy for metronidazole-resistant strains and metronidazole plus clarithromycin-resistant strains. 73 A study from Israel suggested better compliance and fewer adverse effects with sequential treatment when used as a second-line regimen, which they found noninferior to bismuth-based quadruple therapy. 74 A 5-year prospective review in Italy assessed antimicrobial resistance to clarithromycin, metronidazole, and levofloxacin before giving 10-day sequential therapy as first-line therapy.…”

Section: S Equential and Con Comitant Ther Apymentioning

confidence: 99%

Treatment of Helicobacter pylori infection in 2018

et al. 2018

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Treatment options for the eradication of Helicobacter pylori continue to evolve. There have been many guidelines for H. pylori treatment published, which may lead to some confusion. However, most are in agreement with the most recent iteration of the Maastricht treatment guidelines. Triple therapy is still the most frequently used treatment, especially in areas of low clarithromycin resistance. Its best results are achieved when taken for a minimum of 10 days and with high-dose acid suppression. Quadruple therapy is gaining in popularity particularly in areas with increasing resistance to standard triple therapy. Whether three antibiotics, or bismuth and two antibiotics are used, excellent eradication rates are achieved, albeit with increased side effects. Levofloxacin second-line therapy is widely used; however bismuth, when available, is an increasingly successful option. Sequential therapy is challenging in terms of compliance and is no longer recommended. This past year witnessed a notable increase in the number of studies based on antimicrobial susceptibility testing and tailored eradication therapy, reflecting the role of culture-guided treatment, which may well represent the future of H. pylori treatment and prevent the inappropriate use of antibiotics.

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“…When conventional and novel strategies are considered, medical technology solutions are emerging in response to the AMR challenge. Literature reports show that concomitant medication with different antibiotics provides better efficacy in the eradication of bacterial infections compared to sequential or hybrid therapies 103,104. However, the current strategies have reframed from using antibiotics, and therefore, the researchers have a tendency to combine medical technologies for diagnosis, prevention, and therapy in combating bacterial infections.…”

Section: Introductionmentioning

confidence: 99%

Evolving Technologies and Strategies for Combating Antibacterial Resistance in the Advent of the Postantibiotic Era

Karaman

Ercan

Bakay

et al. 2020

Adv Funct Materials

123

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The threats posed by the impending "postantibiotic era" have put forward urgent challenges to be overcome by providing new diagnostic and therapeutic regimes for improved diagnosis and treatment of bacterial infections. Antibiotic resistance and incurable bacterial infections are especially important in a society faced with rapid demographic changes. With very few new antibiotics in the drug development pipeline, not being able to match the pace of antimicrobial resistance evolution, developments within other fields such as materials sciences and medical technologies are required to realize innovative antibacterial approaches. This progress report presents recent advances in especially nanotechnology-based approaches and their concomitant use with complementary antibacterial treatments. Synergistically improved antibacterial activity can be reached by considering novel, promising approaches such as photodynamic and photothermal therapy as well as cold atmospheric pressure treatments as complementary strategies to fight against antibacterial resistance. Moreover, this report describes how these novel technologies can be further improved especially by integration of nanomaterials into the currently applied single modal strategies against bacterial infections.

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Sequential versus concomitant therapy for treatment of Helicobacter pylori infection: an updated systematic review and meta-analysis

Cited by 27 publications

References 56 publications

Hellenic consensus on Helicobacter pylori infection

Hellenic consensus on Helicobacter pylori infection

Treatment of Helicobacter pylori infection in 2018

Evolving Technologies and Strategies for Combating Antibacterial Resistance in the Advent of the Postantibiotic Era

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