Strategy for Treatment of Helicobacter pylori Infection in Adults II. Practical Policy in 2000

Nakajima, Shigenori; Graham, David Y.; Hattori, Takanori; Bamba, Tadao

doi:10.2174/1381612003399013

Cited by 19 publications

(16 citation statements)

References 57 publications

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“…Eradication of H. pylori species brings an improvement in gastritis and prevents the relapse of gastroduodenal ulcers [7]. The efficacy of treatment of gastric infection caused by H. pylori can be reduced by the occurrence of primary or acquired resistance to various drugs, especially metronidazole [6].…”

Section: Discussionmentioning

confidence: 99%

“…Unsuccessful therapy in patients infected with H. pylori is frequently correlated to metronidazole and clarithromycin resistance [4][5][6]. Most authorities agree that optimal therapy of H. pylori infection requires administration of a minimum of two antibiotics in addition to either a proton pump inhibitor or a hydrogen blocker [7]. Among the many antibiotics examined in vitro, only four are clinically useful: amoxycillin, tetracycline, clarithromycin, and metronidazole.…”

Section: Introductionmentioning

confidence: 99%

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Prevalence of Primary <i>Helicobacter pylori</i> Resistance to Several Antimicrobials in a Saudi Teaching Hospital

Eltahawy¹

2002

Med Princ Pract

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Objective: To determine the resistance rate of the most commonly used antimicrobial agents amongst Helicobacter pylori isolates. Methods: The agar disk diffusion method (Kirby Bauer) was utilized to determine the susceptibility of 223 H. pylori strains isolated before treatment. Isolates were tested against metronidazole (5 µg), clarithromycin (15 µg), amoxycillin (10 µg), and tetracycline (30 µg). Results: The resistance rate was 80% for metronidazole and 4% for clarithromycin. Tetracycline and amoxycillin showed very low degree of resistance with 1 (0.4%) and 3 (1.3%) of the strains resistant to these antibiotics, respectively. Age, sex and ethnicity had a remarkable effect on the resistance rate. Conclusion: The results indicate that metronidazole and clarithromycin should not be used as the only antimicrobial agents in the treatment of H. pylori infection. Susceptibility testing using the disk diffusion method is cost-effective in the screening of antimicrobial resistance against H. pylori.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Prevalence of Primary <i>Helicobacter pylori</i> Resistance to Several Antimicrobials in a Saudi Teaching Hospital

Eltahawy¹

2002

Med Princ Pract

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“…Therefore, enhanced compliance can be achieved by optimising the patients' attitude towards treatment regimens and knowledge about their disease and medications, especially concerning treatment-related side effects (such as diarrhoea with AMO) or taste disturbances (with CLA and MET). The rate of side effects occurring during H. pylori eradication is in the range of 10 -50%, with intolerable side effects leading to premature discontinuation of treatment in ≤ 10% of patients [79,80]. suggest that H. pylori eradication therapy may fail more frequently in patients with a homozygous extensive metaboliser status.…”

Section: Host-related Factorsmentioning

confidence: 99%

“…The efficacy of this therapeutic regimen is not affected by resistance to CLA and is able to overcome resistance to MET due to the increased MET dose [134]. Despite the large number of tablets and frequent drug administration, drop-out rates in most clinical trials have been comparable with those of easier triple-therapy regimens [30]; however, adverse events do occur in > 30% of patients with intolerable side effects in ≤ 5% of patients [80,129]. With quadruple therapy as second-line treatment after failure of PPI-based first-line approach, > 80% of patients can be cured [30,133,135,136].…”

Section: Consensus Recommendations 411 Quadruple Therapymentioning

confidence: 99%

Effective regimens for the treatment ofHelicobacter pyloriinfection

Morgner

Labenz

Miehlke

2006

Expert Opinion on Investigational Drugs

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Successful Helicobacter pylori eradication therapy remains a challenge in medical practice. Currently, a proton pump inhibitor-based triple therapy containing clarithromycin, amoxicillin or nitroimidazole for 7 days is the recommended first-line treatment approach with an expected eradication success rate of approximately 80%. As a second-line treatment option in the case of failure, a ranitidine bismuth citrate-based quadruple therapy is currently recommended curing another 80% of patients, leaving a subset of patients with persistent H. pylori infection. For these patients, promising rescue options have been evaluated including regimens that contain rifabutin, quinolones, furazolidone or high-dose amoxicillin. The role of susceptibility testing is still under discussion. It is not generally recommended prior to first-line treatment but guidelines propose a role for culture and antibiotic sensitivity testing after failure of the second attempt. Meanwhile, data on the geographic distribution of resistance pattern are available and may guide therapeutic decisions with regard to the combination of antibiotics chosen for the individual patients aiming at 100% cure rate in each individual patient.

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“…Although H. pylori infection has been implicated as an etiological factor in chronic gastric reflux disease, new studies show that H. pylori infection may provide a protective mechanism against such disease; however, the results of those studies remain controversial (8,18). Eradication therapy heals gastritis and results in cure of peptic ulcer and the remission of mucosa-associated lymphoid tissue-type gastric carcinomas (22). Although most infections can be controlled by antibiotic therapy (17,27), H. pylori antibiotic resistance is becoming somewhat commonplace (1).…”

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confidence: 99%

Three-Dimensional Quantitative Structure-Activity Relationship and Comparative Molecular Field Analysis of Dipeptide Hydroxamic Acid Helicobacter pylori Urease Inhibitors

Mishra¹,

Parrill

Williamson

2002

Antimicrob Agents Chemother

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A homology model of Helicobacter pylori urease was developed by using the crystal structure of urease from Klebsiella aerogenes (EC 3.5.1.5) as a template. The acetohydroxamic acid moiety was docked into the active pocket of the enzyme model, followed by relaxation of the complex by use of molecular dynamics. The resulting conformation was used as a template to construct 24 potential dipeptide hydroxamic acid inhibitors with which comparative molecular field analysis (CoMFA) was performed. The resulting model provided a cross-validation correlation coefficient (q 2 L00 ) of 0.610, a conventional r 2 value of 0.988, and an F (Fisher indication of statistical significance) value of 294.88. We were able to validate the CoMFA model by using the 50% inhibitory concentrations of six compounds that were not included in the construction of the model. A very good structural correlation was observed between the amino acids in the model urease's active pocket and the contour maps derived from the CoMFA model. This correlation, accompanied by the validation supplied by use of the CoMFA data, illustrates that the model can aid in the prediction and design of novel H. pylori urease inhibitors.Helicobacter pylori is a gram-negative, spiral bacterium thought to affect about 90% of the world's population (11). It is well accepted that H. pylori infection is etiologically associated with chronic active gastritis, peptic ulcer diseases, mucosa-associated lymphoid tissue-type gastric carcinoma, and other gastric cancers (16). Although H. pylori infection has been implicated as an etiological factor in chronic gastric reflux disease, new studies show that H. pylori infection may provide a protective mechanism against such disease; however, the results of those studies remain controversial (8, 18). Eradication therapy heals gastritis and results in cure of peptic ulcer and the remission of mucosa-associated lymphoid tissue-type gastric carcinomas (22). Although most infections can be controlled by antibiotic therapy (17, 27), H. pylori antibiotic resistance is becoming somewhat commonplace (1). Antibiotic resistance in a microorganism as widespread as H. pylori is a cause for immediate concern and warrants a dedicated search for the discovery of new drug therapies.H. pylori, characterized by its strong urease activity (5), has received a great deal of attention from the scientific community over the past two decades. It is now clear that for survival the organism requires the production of a urease enzyme to help produce ammonia to counteract the strong acidic environment of the stomach (19). It has been estimated that over 5% of the total protein in the cell is represented by this enzyme (12). The urease reaction not only provides an environment with a pH suitable for H. pylori colonization of the stomach mucosal lining but also provides the mechanism for eventual gastric wall damage that increases the overall likelihood and the severity of gastric ulcers (20). Ureases are ubiquitous in nature and are inhibited, in general, by a var...

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Strategy for Treatment of Helicobacter pylori Infection in Adults II. Practical Policy in 2000

Cited by 19 publications

References 57 publications

Prevalence of Primary <i>Helicobacter pylori</i> Resistance to Several Antimicrobials in a Saudi Teaching Hospital

Prevalence of Primary <i>Helicobacter pylori</i> Resistance to Several Antimicrobials in a Saudi Teaching Hospital

Effective regimens for the treatment ofHelicobacter pyloriinfection

Three-Dimensional Quantitative Structure-Activity Relationship and Comparative Molecular Field Analysis of Dipeptide Hydroxamic Acid Helicobacter pylori Urease Inhibitors

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