Effectiveness of 10 day-sequential therapy for Helicobacter pylori eradication in Korea

BACKGROUND/AIMS: Antibiotic resistance and poor compliance are the main causes of Helicobacter pylori (H. pylori) eradication failure. Proton pump inhibitor (PPI)-based triple therapy is the most preferred regimen in clinical practice. However, a critical fall in the H. pylori eradication rate has been observed in the recent years. A novel 10 day-sequential therapy consists of five days of dual therapy followed by five days of triple therapy regimen has recently been described. We aimed to evaluate whether 10 day-sequential therapy eradicated H. pylori infection better than the PPI-based triple therapy in Korea. METHODS: 158 patients with proven H. pylori infection were randomized to receive either 10 day-sequential therapy (20 mg of omeprazole, 1.0 g of amoxicillin, each administered twice daily for the first 5 days, followed by 20 mg of omeprazole, 500 mg of clarithromycin, 500 mg of metronidazole, each administered twice daily for the remaining 5 days) or PPI-based triple therapy (20 mg of omeprazole, 1.0 g of amoxicillin, 500 mg of clarithromycin, each administered twice daily for 1 week). Outcome of eradication therapy was assessed 8 weeks after the cessation of treatment. RESULTS: Eradication rates of 10 day-sequential therapy and PPI-based triple therapy were 77.9% (60/77) and 71.6% (58/81) by intention to treat analysis, respectively (p=0.361). By per protocol analysis, eradication rates of 10 day-sequential therapy and triple therapy were 85.7% (60/70) and 76.6% (58/76), respectively (p=0.150). There were no significant differences in adverse event rates and treatment compliance between two groups. CONCLUSIONS: The 10 day-sequential therapy regimen failed to achieve significantly higher eradication rates than PPI-based triple therapy.     

Effectiveness of minocycline-based triple therapy for eradication of Helicobacter pylori infection

Background: Widespread use of eradication therapy for Helicobacter pylori has increased the prevalence of clarithromycin‐resistant strains. The purpose of the present paper was to measure the in vitro antibacterial activity of minocycline against H. pylori, and study the effectiveness of minocycline‐based first‐ and second‐line eradication therapies. Methods: For first‐line therapy, 79 patients were randomly assigned to the treatment with rabeprazole, amoxicillin, and clarithromycin or with rabeprazole, amoxicillin, and minocycline. For second‐line therapy, 88 patients were tested for sensitivity to metronidazole: 67 patients with metronidazole‐sensitive strains received a 7‐day course of rabeprazole, minocycline, and metronidazole; the remaining 21 patients were given a 7‐day course of rabeprazole, minocycline, and faropenem. Results: There was virtually no resistance to minocycline among the strains tested. The eradication rate of H. pylori infection in first‐line therapy was significantly lower for minocycline‐containing regimen (38.5%, 15/39) than for clarithromycin‐containing regimen (82.5%, 33/40; P < 0.01). For second‐line therapy, a high eradication rate against metronidazole‐sensitive strains was obtained with rabeprazole, minocycline and metronidazole (85%, 57/67). Conclusions: A combination of rabeprazole, minocycline, and metronidazole is safe and effective for second‐line therapy of H. pylori infection. Because this regimen can be administered to patients with penicillin allergy and patients who suffer adverse reactions to amoxicillin, such as diarrhea and other digestive symptoms, it should be considered useful for second‐ and third‐line eradication therapy.     

Effectiveness of triple therapy and quadruple therapy for Helicobacter pylori eradication]

BACKGROUND/AIMS: Quadruple therapy can be considered as a first-line therapy in areas where the resistance rate to clarithromycin is high. Comparison study of triple therapy and quadruple therapy for Helicobacter pylori (H. pylori) eradication is still lacking in Korea despite the increasing prevalence of antibiotic resistance. This study was conducted to compare the efficacy of triple and quadruple therapy as a first-line treatment in H. pylori infected patients with peptic ulcer. METHODS: Consecutive 149 cases of peptic ulcer disease associated with H. pylori infection were randomized either to proton pump inhibitor (PPI, bid), amoxicillin (1,000 mg, bid), and clarithromycin (500 mg, bid) (PAC group) or to PPI (bid), bismuth subcitrate (300 mg, qid), metronidazole (500 mg, tid), and tetracycline (500 mg, qid) (PBMT group) eradication treatments for 7 days. Outcome of eradication therapy was assessed by 13C-urea breath test performed 4-6 weeks after eradication. RESULTS: Eradication rates in PAC and PBMT group were 78.7% (59/75) and 71.6% (53/74) by intention to treat analysis, respectively (p=0.424). By per protocol analysis, eradication rates of PAC and PBMT group were 85.5% (59/69) and 85.5% (53/62), respectively (p=1.012). Adverse reactions occurred in 5 (6.6%) and 7 (9.5%) patients in PAC and PBMT group, respectively (p=0.346). CONCLUSIONS: One week-quadruple therapy as a first-line treatment for H. pylori infection does not offer any advantage over PPI-based triple therapy in Korean patients.     

共同治疗策略对根除幽门螺杆菌的影响

[目的]研究存在幽门螺杆菌(Hp)感染家庭聚集的感染患者Hp根除治疗后复发情况,探讨共同根除治疗策略对远期根除Hp的影响。[方法]通过对内镜检查确诊的195例Hp感染患者的家庭成员采用13碳呼气试验进行Hp感染调查,筛选有家庭成员Hp感染的患者140例。按照对Hp感染家庭成员有无根除治疗,将140例随机分成家庭成员共同根治组和单独根治组,每组70例。治疗后每月随访患者感染复发情况,观察不同根治策略对Hp根除的影响。[结果]134例患者参与根治后4、6、12、18、24个月随访,其中家庭成员共同根除治疗患者68例,Hp感染复发患者分别为0、1、2、4、5例,累积复发率为7.4%,平均复发时间为(12.6±6.1)个月;而66例单独根治患者复发者则分别为3、5、9、11、13例,累积复发率为19.7%,平均复发时间为(11.1±6.3)个月。χ2检验分析发现,在根除治疗后4、6个月时,2组复发率比较差异无统计学意义(P0.05);随着时间推移,治疗后12、18、24个月,共同根治组患者Hp感染再发率显著少于单独根治组(P0.05)。[结论]从远期观察,对于存在Hp感染家庭聚集的Hp感染患者,Hp感染成员共同根除治疗可有效降低根治后感染再发。     

A successful eradication campaign. Global eradication of smallpox

Smallpox was the first important disease to be eradicated; it was the success of the Smallpox Eradication Programme that inspired this conference. Several biological reasons favored the eradication of smallpox, the most important of which were probably that recurrent infectivity did not occur, that there was no animal reservoir, and that an effective stable vaccine was available. The importance of smallpox as a disease that travelers might import into countries free of smallpox provided a powerful stimulus for its global eradication. This paper highlights some of the problems associated with the eradication of smallpox in two countries where eradication was difficult, India and Ethiopia, and the measures adopted to overcome the problems. The paper also stresses the importance of the development of methods for the certification of smallpox eradication from countries, from regions, and finally from the whole world. It is noted that close links between field work and research were important throughout the eradication campaign.