The MACH2 study: Role of omeprazole in eradication of Helicobacter pylori with 1-week triple therapies

Lind, Tore; Mégraud, Françis; Unge, Peter; Bayerdörffer, Ekkehard; O'Morain¶, Colm; Spiller, Robin C.; Zanten, Sander Veldhuyzen van; Bardhan, Karna Dev; Hellblom, M; Wrangstadh, Michael; Zeijlon, L.; Cederberg, Christer

doi:10.1016/s0016-5085(99)70119-8

Cited by 394 publications

(371 citation statements)

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“…Metronidazole and amoxicillin in combination with a proton pump-inhibitor were used for treatment of H. pylori infection with eradication rate of 80% in Europe. 19 However, this triple therapeutic regimen was found to be less than 60% efÞ cient among Iranian population. 20 In this study, 72.6% of H. pylori isolates were resistance to metronidazole and therefore, recurrence of the infection with H. pylori could be expected among patients receiving the above mentioned triple therapy.…”

Section: Discussionmentioning

confidence: 99%

Antimicrobial susceptibility testing of <i>Helicobacter pylori </i>to selected agents by agar dilution method in Shiraz-Iran

Kohanteb¹,

Bazargani²,

Saberi-Firoozi³

et al. 2007

Indian J Med Microbiol

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Section: Discussionmentioning

confidence: 99%

Antimicrobial susceptibility testing of <i>Helicobacter pylori </i>to selected agents by agar dilution method in Shiraz-Iran

Kohanteb¹,

Bazargani²,

Saberi-Firoozi³

et al. 2007

Indian J Med Microbiol

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“…The results of different combinations of dual therapy such as a PPI plus amoxicillin, plus clarithromycin, plus metronidazole were established long ago as well as differences that can be expected by changes in dose and duration of these combinations 13,[52][53][54][55][56] . Generally, the results of therapy in the face of specific antimicrobial resistance mirror what would be expected based on loss of the antibiotic from the combination.…”

Section: Predicting the Effect Of Resistance On Treatment Successmentioning

confidence: 99%

New concepts of resistance in the treatment of Helicobacter pylori infections

Graham

Shiotani

2008

Nat Rev Gastroenterol Hepatol

312

368

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SummaryThe prevalence of antimicrobial resistance is now such that all patients should be considered as having resistant infections. Ideally therapy is based on pretreatment susceptibility testing. Empiric therapies should assume antimicrobial resistance and use higher doses for 14 days. Acceptable results are 90-94% cure intention to treat (Grade B) or greater. Clarithromycin-containing triple therapies now typically produce ≤80% cure ITT (Grade F) and are no longer acceptable empiric therapy. Current initial therapy options are between sequential therapy, concomitant therapy, and bismuth containing quadruple therapy. Sequential therapy has the potential to be improved to ≥95% cure ITT (Grade A) by continuing the amoxicillin through the second and/or by increasing the duration. Better appreciation of the role of acidity in phenotypic resistance has resulted in high cure rates with high dose PPI plus amoxicillin dual therapy; additional studies to devise better dual-based multidrug regimes are still needed. Antimicrobial choices following treatment failure is best approached by susceptibility testing. If not available, we recommended a bismuth containing quadruple therapy substituting a new drug for metronidazole/tinidazole and/or clarithromycin if they have been used previously. The alternate would be to use a 14 day high dose PPI, amoxicillin-based triple therapy with rifabutin, a fluoroquinolone, or furazolidone. KeywordsHelicobacter pylori; therapy; resistance; antibiotics; anti-secretory drugs; phenotypic drug resistance; cytochrome P450 "To read without reflecting is like eating without digesting". -86-462-1111-86-462- , FAX 81-86-464-1195 Review criteria: We searched the relevant papers by using computer-assisted bibliographic searches of PubMed through November 30, 2007 using combinations of the following terms: H. pylori combined with resistance, therapy, eradication, second, triple, quadruple, sequential, or rescue. We also reviewed the recent literature on pharmacokinetics and pharmacodynamics in relation to the drugs used in H. pylori therapy and the relation to host cytochrome P450 genotypes to treatment outcome. We did not perform meta-analyses. We reviewed only articles published in English.

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“…In fact, the number of intakes and in loco action of the antibiotics might play an important role on H. pylori eradication, since it is possible that the ultra-short regimen reduces antibiotic concentration on the gastric mucosa 36 . Omeprazole induces bacterial growth, and short-term use can prevent an opportunity for a more powerful antibacterial action 37 .…”

Section: Discussionmentioning

confidence: 99%

Low efficacy of an ultra-short term, once-daily dose triple therapy with omeprazole, azithromycin, and secnidazole for Helicobacter pylori eradication in peptic ulcer

et al. 2002

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PURPOSE:To determine the eradication rate of an ultra-short treatment schedule for Helicobacter pylori infection in a population with peptic ulcers, using omeprazole, secnidazole, and azithromycin in a once-daily dose for 3 days.METHODS: Thirty patients with peptic ulcer diagnosed by upper endoscopy and for Helicobacter pylori infection by rapid urease test and histologic examination received omeprazole 40 mg, secnidazole 1000 mg, and azithromycin 500 mg, administered once daily for 3 days. A follow-up exam was performed 12 weeks after the end of the treatment. Patients who were negative for Helicobacter pylori infection by rapid urease test and histologic examination were considered cured.RESULTS: Patients were predominantly female, and the mean age was 50 years. Duodenal peptic ulcer was found in 73% of the patients. Eradication was achieved in 9 of the 28 (32%) patients as determined from the follow-up endoscopic exam. The eradication rate by intention to treat was 30%. Side effects were present in 3% of the patients, and compliance to treatment was total.CONCLUSIONS: In spite of the low rate of side effects and good compliance, the eradication index was low. A possible drawback of this therapy is that it reduces the efficacy of macrolide and nitroimidazole compounds in subsequent treatments. DESCRIPTORS: Peptic Ulcer/Treatment. Helicobacter pylori/Eradication. Secnidazole/Therapeutic use. Azithromycin/ Therapeutic use. Omeprazole/Therapeutic use.

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The MACH2 study: Role of omeprazole in eradication of Helicobacter pylori with 1-week triple therapies

Cited by 394 publications

References 10 publications

Antimicrobial susceptibility testing of <i>Helicobacter pylori </i>to selected agents by agar dilution method in Shiraz-Iran

Antimicrobial susceptibility testing of <i>Helicobacter pylori </i>to selected agents by agar dilution method in Shiraz-Iran

New concepts of resistance in the treatment of Helicobacter pylori infections

Low efficacy of an ultra-short term, once-daily dose triple therapy with omeprazole, azithromycin, and secnidazole for Helicobacter pylori eradication in peptic ulcer

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