Treatment of Helicobacter pylori infection 2017

Abstract

Over the last decade, it has been widely reported that the success of Helicobacter pylori eradication treatment is falling. A steady decline was observed in the number of patients achieving eradication with standard first-line triple therapy of two antibiotics and a proton pump inhibitor [1][2][3]. It now appears that the first-line eradication therapies most commonly used in everyday clinical practice fall considerably short of the 80% intention-to-treat (ITT) eradication rates that are considered the minimal acceptable levels as recommended in the Maastricht guidelines [4]. Interestingly, two studies emerged from Asian centers in the last 12 months, which show that, in this part of the world at least, eradication levels using standard therapies remain close to 80%. A Malaysian study showed a standard 1-week pantoprazole, amoxycillin, and clarithromycin regimen to be well tolerated and highly efficacious with a per-protocol eradication rate of 84% [5]. A Japanese study showed remarkably consistent per-protocol eradication rates from 2001 to 2009 fluctuating between 75 and 78% for standard 7-day triple-therapy regimens [6]. A limit of many studies especially those including clarithromycin or levofloxacin is that H. pylori susceptibility to the drugs, which is the main prediction of failure, was not tested. LevofloxacinThe use of levofloxacin as a first-line therapy has been examined in great depth in the last year. Levofloxacin may be used as a substitute for clarithromycin in either a standard triple or sequential regimen. A large study comparing the antibiotics in either regimen shows a clear advantage to levofloxacin in both combinations. Per-protocol cure rates for triple therapy were 66% for omeprazole-clarithromycin-amoxycillin compared with 83% for omeprazole-levofloxacin-amoxycillin and 81% for omeprazole-amoxycillin-clarithromycin-metronidazole vs 85% for omeprazole-amoxycillin-levofloxacinmetronidazole, with no difference in compliance rates or adverse events [7]. It has been proposed that sequential levofloxacin-based regimens are of most benefit in areas where clarithromycin resistance is in excess of 15%, and another study in such an area showed eradication rates of 81% with clarithromycin sequential therapy compared with 96% with levofloxacin sequential therapy. A third arm in this study looked at the dose of levofloxacin required and illustrated no benefit in increasing the dose from 250 to 500 mg [8]. Indeed, another study went so far as to suggest that once-daily dosing of a levofloxacin-based triple regimen may be as efficacious as twice daily [9]. The literature from Asia also seems to support levofloxacin as a good alternative first-line therapy. A study on a triple regimen showed per-protocol eradication rates of 78% for standard clarithromycin-containing therapies compared with 83% for a levofloxacin-based regimen [10]. Another study from the Middle East looked at whether combining clarithromycin and levofloxacin in the same regimen could be Keywords Peptic ulcer disease, resistance, compli...

Bismuth‐containing quadruple therapy versus concomitant quadruple therapy as first‐line treatment for Helicobacter Pylori infection in an area of high resistance to clarithromycin: A prospective, cross‐sectional, comparative, open trial

“…1 In Spain, H. pylori approximately infects 50% of the population, 2 but the prevalence is even higher in the northwest of Spain (up to 70%). 4 Current consensus guidelines highlight the importance of knowing local H. pylori resistance patterns, 1,2,5 and the use of therapeutic regimens that can ensure at least a 90% success rate in a particular region is recommended. 4 Current consensus guidelines highlight the importance of knowing local H. pylori resistance patterns, 1,2,5 and the use of therapeutic regimens that can ensure at least a 90% success rate in a particular region is recommended.…”

“…3 In recent years, H. pylori eradication rates with conventional triple therapies have fallen to unacceptable levels. 4 Current consensus guidelines highlight the importance of knowing local H. pylori resistance patterns, 1,2,5 and the use of therapeutic regimens that can ensure at least a 90% success rate in a particular region is recommended. 1 In this context, the use of empiric triple clarithromycin-containing regimens is discouraged by most recent guidelines if local resistance to clarithromycin is >15%.…”

Intraluminal therapy for Helicobacter pylori infection

“…5,6 This is attributable to the special gastric milieu of H. pylori, which leads to more difficult and complicated treatment regimens to achieve its successful eradication in contrast to other bacterial infections. Several strategies [7][8][9] have been proposed to increase the eradication rate and decrease the antibiotic resistance, including extension of treatment duration, increasing doses, using four-drug nonbismuth-containing (sequential, hybrid, and concomitant) and bismuth-containing quadruple therapies or even five-drug quintuple therapy, 10 use of other antibiotics such as levofloxacin, 9 azithromycin, 11 rifabutin, 12,13 and furazolidone, 14 using a high-dose proton pump inhibitor 15 or a novel potassium-competitive acid blocker (vonoprazan), [16][17][18] dual therapy, 8 use of bismuth-enhanced triple therapy 19 or susceptibility-guided therapy, [20][21][22] and the supplementation of probiotics. 8,23,24 However, the current multiple-dose antibiotic therapies still steadily increase the rate of worldwide antibiotic resistance, which becomes a leading international medical problem.…”

Effectiveness and safety of furazolidone‐containing quadruple regimens in patients with Helicobacter pylori infection in real‐world practice

“…Helicobacter pylori (H pylori) is a gram-negative organism that causes gastric inflammation, peptic ulcer, gastric cancer, and mucosa-associated lymphoid tissue (MALT) lymphoma. 1 It is one of the most prevalent infectious agents in the world, and approximately half of Asian populations are infected with this organism. 2 The Kyoto global consensus report on H pylori gastritis defined H pylori as an infectious disease and suggested that all with H pylori infection should receive eradication treatment.…”