Update on non-bismuth quadruple (concomitant) therapy for eradication of Helicobacter pylori

Gisbert, Javier P.; Calvet, Xavier

doi:10.2147/ceg.s25419

Cited by 122 publications

(97 citation statements)

References 92 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Furthermore, if eradication fails, no second-line treatment regimen has been established [95] . Concomitant therapy, also known as non-bismuth quadruple therapy, consists of PPI and all three antibiotics (clarithromycin, amoxicillin, metronidazole) administered concomitantly to provide a simpler treatment regimen compared to sequential therapy [96] . Recently, several studies have compared concomitant therapy to STT and sequential therapy.…”

Section: Are There Suitable Sequential and Concomitant Therapy Alternmentioning

confidence: 99%

Antibiotic treatment forHelicobacter pylori: Is the end coming?

Kim

Choi

Chung

2015

WJGPT

View full text Add to dashboard Cite

Infection with the Gram-negative pathogen Helicobacter pylori (H. pylori ) has been associated with gastroduodenal disease and the importance of H. pylori eradication is underscored by its designation as a group I carcinogen. The standard triple therapy consists of a proton pump inhibitor, amoxicillin and clarithromycin, although many other regimens are used, including quadruple, sequential and concomitant therapy regimens supplemented with metronidazole, clarithromycin and levofloxacin. Despite these efforts, current therapeutic regimens lack efficacy in eradication due to antibiotic resistance, drug compliance and antibiotic degradation by the acidic stomach environment. Core tip: This article reviews the recent literature describing antibiotic resistance and trends in Helicobacter pylori (H. pylori ) treatment. As there is no effective conventional therapy, new treatments are being developed and bismuth quadruple, sequential, concomitant therapies are recommended as a first-line regimen in regions with high levels of clarithromycin resistance. Quinolones have also been used for H. pylori treatment, although the cure rate has gradually reduced with this approach. New therapeutic directions include probiotic supplementation, tailored therapy, novel agents, and nanotechnology.

show abstract

Section: Are There Suitable Sequential and Concomitant Therapy Alternmentioning

confidence: 99%

Antibiotic treatment forHelicobacter pylori: Is the end coming?

Kim

Choi

Chung

2015

WJGPT

View full text Add to dashboard Cite

show abstract

“…The superiority of this therapy over standard triple therapy has been widely documented (7). Meanwhile, concomitant therapy, first introduced in 1998 (8,9), is now being reconsidered as a firstline H. pylori eradication therapy (10). The concomitant regimen includes quadruple therapy with standard triple therapy (PPI, clarithromycin, amoxicillin) plus metronidazole or tinidazole.…”

Section: Introductionmentioning

confidence: 99%

Meta-Analysis of Sequential, Concomitant and Hybrid Therapy for <i>Helicobacter pylori</i> Eradication

Deng

Luo

2015

Intern. Med.

View full text Add to dashboard Cite

Objective To compare the efficacy of sequential therapy, concomitant therapy and hybrid therapy for the treatment of Helicobacter pylori (H. pylori) infection. Methods PubMed, Web of Science, Medline, Embase, the Cochrane Central Register of Controlled Trials and CNKI were searched up to the end of May 10, 2014 in order to identify all randomized controlled trials (RCTs) reporting the effects of sequential therapy, concomitant therapy and hybrid therapy on H. pylori eradication. The relative risk (RR) of eradicating H. pylori infection after sequential therapy compared with concomitant therapy or hybrid therapy was pooled. The eradication rates were considered both on an intention-to-treat (ITT) and per-protocol (PP) basis. Results A total of 10 RCTs involving 3,501 patients were included. The pooled data suggested that the differences between the three groups were not statistically significant (ITT analysis: sequential therapy vs. concomitant therapy: RR=1.01, 95%confidence interval (CI): 0.97-1.04, sequential therapy vs. hybrid therapy: RR=1.02, 95%CI: 0.85-1.22, concomitant therapy vs. hybrid therapy: RR=1.03, 95%CI: 0.97-1.08; PP analysis: sequential therapy vs. concomitant therapy: RR=1.00, 95%CI: 0.96-1.03, sequential therapy vs. hybrid therapy: RR=0.97, 95%CI: 0.86-1.09, concomitant therapy vs. hybrid therapy: RR=1.01, 95%CI: 0.93-1.10). In the ITT and PP analyses, the overall eradication rates were 84.3% (95%CI: 79.1-89.4) and 86.4% (95%CI: 81.7-91.0) for the sequential therapy group, 86.7% (95%CI: 81.0-92.3) and 89.8% (95%CI: 85.1-94.5) for the concomitant therapy group and 86.6% (95%CI: 82.3-91.0) and 92.7% (95%CI: 90.5-94.9) for the hybrid therapy group, respectively. There were no significant differences among these therapies in terms of the rate of side effects. Conclusion The pooled evidence suggests that sequential therapy, concomitant therapy and hybrid therapy are similar with respect to the treatment of H. pylori infection.

show abstract

“…Short-term duration therapeutic regimens have many benefits including lower cost, higher compliance, as well as lower side effects and drug resistance 12,13 .…”

Section: Discussionmentioning

confidence: 99%

“…This issue has led to conduct vast research on alternative first-line therapeutic regimens and the investigation on Sequential, concomitant and hybrid therapy regimens has been suggested. Concomitant regimen has been defined as quadruple therapy containing proton pump inhibitor with three antibiotics with or without bismuth that has been studied in various time intervals of 3 days to 14 days 12,13 . Considering the rising resistance to some antibiotics and declining the efficacy of common therapeutic regimens, this study aimed to compare the effectiveness between the classic triple therapy regimen and seven day concomitant therapy regimen to achieve therapeutic regimens with optimal therapeutic efficacy.…”

mentioning

confidence: 99%

Untitled

2017

IJPSR

View full text Add to dashboard Cite

There are various treatment regimens including different antibiotics and antacid medications for eradicating Helicobacter pylori to compare the effectiveness of 7-day concomitant regime with classic triple regimen in eradicating H. pylori. In this randomized clinical trial, 206 dyspeptic patients proven H. pylori infection, attended to a gastrointestinal clinic in Khorramabad (west of Iran) were studied. The patients were randomly divided in two equal groups. Classic group were treated for 14 days with a regimen including omeprazole 20mg, amoxicillin 1g and clarithromycin 500mg, twice daily. In concomitant group, the patients were treated for 7 days with a regimen including omeprazole 20mg, amoxicillin 1g, clarithromycin 500mg and metronidazole 500mg twice daily. During the treatment period and a week after the end of treatment, the patients were evaluated in terms of possible side-effects and medication acceptance and tolerance. For confirmation of eradication, 6 weeks after the end of treatment, urea breath test with carbon 13 (UBT) was done for both the groups. Data were analyzed using descriptive statistics, T-test and chi-square test, logistic regression through SPSS software version 21. The level of significance was considered less than 0.05. H. pylori eradication rate in classic group was 68.9% and in concomitant group was 83.4%. (p -value = 0.03). The incidence of gastrointestinal side-effects was not statistically different between the groups. H. pylori eradication rate in 7-day concomitant treatment regimen is more than 14-day classic regimens. Therefore, it is suggested to use 7-day concomitant regimen as first-line of H. pylori eradication.

show abstract

Update on non-bismuth quadruple (concomitant) therapy for eradication of Helicobacter pylori

Cited by 122 publications

References 92 publications

Antibiotic treatment forHelicobacter pylori: Is the end coming?

Antibiotic treatment forHelicobacter pylori: Is the end coming?

Meta-Analysis of Sequential, Concomitant and Hybrid Therapy for <i>Helicobacter pylori</i> Eradication

Untitled

Contact Info

Product

Resources

About