Ten-Day Quadruple Therapy Comprising Low-Dose Rabeprazole, Bismuth, Amoxicillin, and Tetracycline Is an Effective and Safe First-Line Treatment for Helicobacter pylori Infection in a Population with High Antibiotic Resistance: a Prospective, Multicenter, Randomized, Parallel-Controlled Clinical Trial in China

Xie, Yong; Zhu, Zhenhua; Wang, Jiangbin; Zhang, Lingxia; Zhang, Zhenyu; Lü, Hong; Zeng, Zhirong; Chen, Shiyao; Li, Dongsheng; Lv, Nonghua

doi:10.1128/aac.00432-18

Cited by 29 publications

(40 citation statements)

References 24 publications

(33 reference statements)

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“…33 While some large-scale, multicenter studies from China revealed that clarithromycin resistance had little influence on the efficiency of bismuth quadruple regimen containing clarithromycin. 34,35 Besides, the Maastricht V consensus, the Toronto Consensus, and the ACG Clinical Guideline also recommend bismuth used for regions with high rates of clarithromycin resistance, because of its synergistic effects combined with antimicrobial agents to improve eradication rates. 10,11,36,37 Our results showed that clarithromycin-containing bismuth quadruple therapy was quite effective irrespective of the resistance and dose of clarithromycin.…”

Section: Discussionmentioning

confidence: 99%

Half‐dose clarithromycin‐containing bismuth quadruple therapy is effective and economical in treating Helicobacter pylori infection: A single‐center, open‐label, randomized trial

Wang

et al. 2019

Helicobacter

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Background Clarithromycin‐containing bismuth quadruple therapy has been recommended as the first‐line therapy for H pylori infection in China. However, its expensive cost and high antibiotic‐related adverse reactions are always haunting us. To find a safer, more cost‐effective, and high eradicative strategy for Helicobacter treatment, we investigated the efficacy of 14‐day bismuth quadruple therapy and different doses of clarithromycin in the first‐line treatment. Method A total of 210 patients with H pylori infection were recruited and randomly assigned to half‐dose clarithromycin group (esomeprazole 20 mg bid, amoxicillin 1 g bid, clarithromycin 250 mg bid, and bismuth potassium citrate 0.6 g bid) for 14 days or standard‐dose clarithromycin group (esomeprazole 20 mg bid, amoxicillin 1 g bid, clarithromycin 500 mg bid, and bismuth potassium citrate 0.6 g bid) for 14 days. A 13C‐urea breath test (13C‐UBT) was performed at least 4 weeks after treatment. The eradication rate of H pylori, the incidence of side effects, and the cost‐effectiveness of regimens were evaluated in this study. Results The eradication frequencies were 86.67% for both groups in the intention‐to‐treat analysis, while the per‐protocol eradication rates were 91% vs. 91.92% (p=0.817). The incidence of adverse events was higher in standard dose group (54.21% vs. 34.29%; p=0.004), especially bitter taste symptom. There was a higher level of costs per person associated with the standard‐dose group as compared with half‐dose group (￥804.3 vs ￥654.36). The cost‐effectiveness ratio of the half dose was less than that of the standard dose (7.55 vs 9.16 CNY per percent). Conclusions A 14‐day half‐dose clarithromycin‐containing bismuth quadruple regimen is as effective as the standard bismuth quadruple therapy at eradicating H pylori, which is better tolerated and more economical. (ChiCTR‐ROC‐15007406).

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Section: Discussionmentioning

confidence: 99%

Half‐dose clarithromycin‐containing bismuth quadruple therapy is effective and economical in treating Helicobacter pylori infection: A single‐center, open‐label, randomized trial

Wang

et al. 2019

Helicobacter

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“…Resistance to clarithromycin has a greater impact on the efficacy of treatment regimens. Multiple studies have suggested that efficacy can be reduced by up to 70% and this is the reason it has been considered responsible for failure in eradication with triple standard therapy [2,10,11,[13][14][15]. For tetracycline and amoxicillin, studies on the impact of resistance on treatments have not been carried out because today the rates are kept below 5% [16][17][18][19][20][21].…”

Section: Introductionmentioning

confidence: 99%

Surveillance of the Antimicrobial Resistance Rates of <b><i>Helicobacter pylori</i></b> Ten Years Later in the Western Central Region, Colombia

Bedoya-Gómez

Aldana

Moncayo

et al. 2019

Dig Dis

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Background: Helicobacter pylori is a bacterium associated with gastroduodenal disease and gastric cancer. Empirical therapy in the treatment of H. pylori infection increases the risk of apparition of antimicrobial drug resistance. In a previous report, in H. pylori clinical isolates, resistance rates to commonly used antimicrobial drugs were as follows: metronidazole 82%, clarithromycin 3.8%, and amoxicillin 1.9%. The aim was to establish the variation of resistance rates and the detection of H. pylori genetic mutations isolated from dyspeptic patients. Methods: Antimicrobial susceptibility profiles were performed by the E-test method for metronidazole, clarithromycin, amoxicillin, and tetracycline in 61 clini-cal isolates. Sequencing was performed to detect mutations associated with resistance to clarithromycin. Results: According to our results, resistance rates found in the 61 isolates were 78.60% for metronidazole and 8.20% for clarithromycin. None of the studied isolates had resistance to tetracycline and amoxicillin. Secondary resistance rates displayed an increase when compared to primary rates for metronidazole (87.50 vs. 77.35%) and for clarithromycin (25.66 vs. 5.66%). Of 5 isolates resistant to clarithromycin, 3 had the A2143G mutation. By comparing the results in this work with previous reports, antimicrobial drug resistance rates did not show major modifications for metronidazole, amoxicillin, and tetracycline during the last 10 years. For clarithromycin, the resistance rate showed a moderate increase; nevertheless, it remains low (< 15%) and this change was not statistically significant. Conclusion: Together, all findings in this work indicate that these antimicrobial drugs can still be used as first line of defense on infected patients living in this region of the country.

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“…48 The second, from a region of high resistance, compared a number of regimens consisting of varying doses of rabeprazole with bismuth, amoxicillin, and either clarithromycin or tetracycline and found all to obtain eradication rates in the region of 86% to 88%. 49 In Iran, another study of first-line patients with duodenal ulcer showed equivalent eradication rates for bismuth quadruple therapy whether amoxicillin or tetracycline was used. 50 In the case of penicillin-allergic patients, a study from China reported an eradication rate of 85% for patients receiving bismuth, esomeprazole, clarithromycin, and metronidazole compared to 64% for those receiving antibiotics without bismuth.…”

Section: B Is Muth -Ba S Ed Ther Apymentioning

confidence: 99%

Review: Treatment of Helicobacter pylori Infection 2019

et al. 2019

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This review summarizes important studies regarding Helicobacter pylori therapy published from May 2018 to May 2019. The main themes that emerge involve studies assessing the efficacy of bismuth‐based regimens. While in recent years the efficacy of bismuth‐based quadruple therapy as a second‐line therapy has been clearly established, there is now substantial evidence that it is the best performing first‐line therapy. Antibiotic resistance was again intensely studied this year, and a clear and dramatic increase in resistance is noted for clarithromycin and levofloxacin; most notably, it may not be possible to support these therapies in most regions of the world much longer without testing. The utility of vonoprazan as an alternative to proton‐pump inhibitor therapy, especially in resistant and difficult to treat groups, has also been considered in greater detail this year, as well as means of supporting and enhancing adherence to therapy. Several studies showed that the diversity of gut microbiota was significantly altered shortly after H pylori eradication. However, the diversity was restored to pre‐treatment state after 2 months in patients treated with triple therapy. More studies are warranted to assess the long‐term changes of gut microbiota after H pylori eradication.

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Cited by 29 publications

References 24 publications

Half‐dose clarithromycin‐containing bismuth quadruple therapy is effective and economical in treating Helicobacter pylori infection: A single‐center, open‐label, randomized trial

Half‐dose clarithromycin‐containing bismuth quadruple therapy is effective and economical in treating Helicobacter pylori infection: A single‐center, open‐label, randomized trial

Surveillance of the Antimicrobial Resistance Rates of <b><i>Helicobacter pylori</i></b> Ten Years Later in the Western Central Region, Colombia

Review: Treatment of Helicobacter pylori Infection 2019

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