Comparison of levofloxacin-containing sequential and standard triple therapies for the eradication of Helicobacter pylori

BackgroundThere is an important concern about the success of standard triple treatment for Helicobacter pylori (H. pylori) in recent years. Better eradication rates have been reported with sequential treatment in current studies. This study aimed to compare the success of a novel levofloxacin-containing sequential regimen with standard triple therapy.MethodsH. pylori-positive patients with non-ulcer dyspepsia were randomly allocated to one of the study groups. The patients on sequential arm were given esomeprazole 40 mg BID and amoxicillin 1 g BID for the first week followed by esomeprazole 40 mg BID, levofloxacin 500 mg QD and metronidazole 500 mg TID for the second week. The patients on standard triple arm were given esomeprazole 40 mg BID, amoxicillin 1 g BID and clarithromycin 500 mg BID for 2 weeks. Eradication was assessed by urea breath test on 6th weeks.ResultsSeventy-five patients were enrolled in each group; 72 in sequential arm and 67 in standard arm completed the protocols. H. pylori eradication rate of per protocol was 90% in sequential versus 57% in standard treatment groups with a statistical significance (p < 0.000). Both regimens were similarly well tolerated and side effects were comparable. Only one patient in sequential arm stopped the treatment because of side effects.ConclusionThe levofloxacin-containing sequential therapy is a significantly better strategy than the standard triple treatment for H. pylori eradication. Standard triple treatment is no more effective for H. pylori in our population and levofloxacin-containing sequential regimen might be used as a first-line eradication option.     

Penbactam for Helicobacter pylori eradication: A randomised comparison of quadruple and triple treatment schedules in an Iranian population

Background & study aimsSelection of the best drug regimens for eradication of Helicobacter pylori infection especially in patients at risk of peptic ulcer relapses and the development of complications is challenging. This study assessed and compared the efficacy of the two common PPI based triple therapies to a quadruple therapy including PPI, metronidazole, amoxicillin and a bismuth compound in Iranian population.Patients & MethodsThree hundred and thirty patients with peptic ulcer and H. pylori infection were included in the study. Patients were randomly assigned to one of the three treatment protocols all given twice daily: (a) A 14-day quadruple therapy (OMAB group) comprising omeprazole 20 mg, metronicazole 500 mg, amoxicillin 1 g, and bismuth subcitrate 240 mg; (b) A 14-day triple regimen (OCP group) comprising omeprazole 20 mg plus clarithromycine 500 mg and penbactam 750 mg and (c) A 14-day triple regimen (OCA group) comprising omeprazole 20 mg plus clarithromycine 500 mg and amoxicillin 1 g. Cure was defined as a negative urea breath test at least six weeks after treatment.ResultsThe per-protocol eradication rates achieved with both OCP regimen (87.0%) and OCA treatment (90.8%) were significantly higher than the OMAB treatment protocol (56.0%); however, no significant difference emerged in eradication rates between the two triple treatment schedules. No significant differences between the groups were found in most side-effects.ConclusionTwo-week quadruple therapy showed a lower eradication rate compared to common triple treatment schedules when used as first-line eradication treatment for H. pylori infection in Iranian population.     

Effect of Helicobacter pylori eradication on glycaemia control in patients with type 2 diabetes mellitus and comparison of two therapeutic regimens

Background and study aimsThe eradication rate of Helicobacter pylori (H. pylori) has been reported as being lower in patients with type 2 diabetes mellitus (DM) than in those without DM. The aim of the study was to assess the efficacy of the two H. pylori eradication regimens in patients without and with type 2 DM and to study the effect of H. pylori treatment on glycaemia control.Patients and MethodsA total of 93 consecutive type 2 DM (non-insulin users) and 98 non-diabetic age- and sex-matched patients were enrolled. Patients were randomly assigned to one of the two treatment protocols all given twice daily: (a) a 14-day quadruple therapy comprising of omeprazole 20 mg, metronidazole 500 mg, amoxicillin 1 g and bismuth subcitrate 240 mg (OMAB) and (b) a 14-day triple regimen comprising of omeprazole 20 mg plus clarithromycin 500 mg and amoxicillin 1 g (OCA). Cure was defined as a negative ¹³C-urea breath test at least 6 weeks after treatment.ResultsThe H. pylori eradication rate with the OCA regimen was 63% in patients with type 2 DM (non-insulin users) and 87.7% in the control group (p = 0.017). The H. pylori eradication rate with the OMAB regimen was 38.2% in patients with type 2 DM and 55.1% in the control group (p < 0.001). Mean decrease of fasting plasma glucose and HbA1c level shows no statistically significant difference after H. pylori eradication.ConclusionThis study suggests that the eradication rate of H. pylori with OCA or OMAB treatment is lower in patients with type 2 diabetes than in non-diabetics and H. pylori treatment in patients with type 2 DM has no role in the control of the glycaemia. The triple therapy (OCA) is superior to the quadruple protocol (OMAB) in H. pylori eradication of both DM and non-DM cases.     

The efficacy of ranitidine bismuth citrate,amoxicillin and doxycycline or tetracycline regimens as a first line treatment for Helicobacter pylori eradication

BackgroundThe eradication rates of Helicobacter pylori (H. pylori) clearly decreased with standard PPI-based triple therapies.AimTo assess the efficacy of two different triple therapies consisting of ranitidine bismuth citrate–amoxicillin–doxycycline and ranitidine bismuth citrate–amoxicillin–tetracycline combinations as a first line treatment option.MethodsOne hundred and fifteen consecutive dyspeptic patients in whom H. pylori infection was diagnosed for the first time were enrolled in this study. The patients were randomized into two groups. Group 1 (n = 57) was assigned to receive a 14-day triple therapy consisting of ranitidine bismuth citrate 400 mg (b.i.d), amoxicillin 1 g (b.i.d) and doxycycline 100 mg (b.i.d). Group 2 (n = 58) was assigned to receive a 14-day triple therapy consisting of ranitidine bismuth citrate 400 mg (b.i.d), amoxicillin 1 g (b.i.d) and tetracycline 500 mg (q.i.d).ResultsThe eradication was achieved in 45.7% (21/46) and 40.8% (20/49) of the patients in group 1 and group 2, according to per protocol analysis. The intention-to-treat eradication rates were 36.8% (21/57) and 34.5% (20/58) in group 1 and group 2, respectively.ConclusionsTwo-week therapy with neither ranitidine bismuth citrate–amoxicillin–doxycycline nor ranitidine bismuth citrate–amoxicillin–tetracycline is adequately effective for H. pylori eradication as a first line therapy.     

High efficacy of bismuth subcitrate for Helicobacter pylori eradication in pangastritis

BackgroundThe influence of gastritis patterns in Helicobacter pylori eradication rates has been poorly investigated.AimsTo compare the efficacy of bismuth or proton pump inhibitors triple therapy for H. pylori eradication in pangastritis.Patients and methodsOne hundred and eight patients with pangastritis were assigned to either lansoprazole 30 mg once a day (n = 54) or bismuth 240 mg bis in die (n = 54) for 14 days combined, for the first week, with amoxicillin 1 g plus metronidazole 250 mg tris in die. Eradication was confirmed by ¹³C-urea breath test.ResultsWith bismuth, successful eradication was observed in 75.9% (41/54) in the intention-to-treat analysis and 78.8% (41/52) in the per-protocol analysis. With lansoprazole, the eradication rates were respectively 46.3% (25/54) and 51.0% (25/49). Bismuth had a significant higher efficacy according to both intention-to-treat analysis (p = 0.0029) and per-protocol analysis (p = 0.0038) with OR of 3.66 (95% CI: 1.61–8.32) and 3.58 (95% CI: 1.50–8.54) respectively. At regression analysis, the only independent variable affecting eradication was the type of regimen (p = 0.026) with an OR of 3.31 (95% CI: 1.16–9.44).ConclusionsIn pangastritis patients, bismuth is more effective than PPI in first-line eradication. For improving the overall eradication rates, an evaluation of gastritis extent might need to be considered.     

Efficacy and safety of Levofloxacin,Clarithromycin and Esomeprazol as first line triple therapy for Helicobacter pylori eradication in Middle East. Prospective,randomized, blind,comparative, multicenter study

Background/aimsAntibiotic resistance and poor compliance are the main causes of Helicobacter pylori (H. pylori ) eradication failure. This study evaluated the eradication rate, tolerability, and compliance of Levofloxacin, Clarithromycin and Esomeprazol combined triple therapy for H. pylori eradication.Patients and methodsFour hundred-fifty patients from 3 centres who were diagnosed to have Helicobacter pylori infection by ¹³C-urea breath test were randomized into 3 equal groups; group 1 (CAE) received Clarithromycin 500 mg twice daily, Amoxicillin 1000 mg twice daily, plus Esomeprazol 20 mg twice daily for 7 days, group 2 (LAE) received Levofloxacin 500 mg once daily, Amoxicillin 1000 mg twice daily, plus Esomeprazol 20 mg twice daily for 7 days, group 3 (CLE) received Levofloxacin 500 mg once daily, Clarithromycin 500 mg twice daily, plus Esomeprazol 20 mg twice daily for 7 days. 436 patients were re-evaluated by ¹³C-urea breath test after 6 weeks from completion of treatment.ResultsH. pylori eradication (intention to treat) was successful in 136/150 (90.6%) with CLE, 127/150 (84.7%) with LAE and 118/150 (78.6%) with CAE. There was a significant difference (p < 0.001) regarding treatment success between CLE and LAE when compared with CAE. There was no difference among the treatment groups with regard to the incidence and severity of adverse events reported.ConclusionThe combined Levofloxacin, and Clarithromycin and Esomeprazol based regimen as first line triple therapy for H. pylori eradication can give more significant eradication rate with same safety when compared with classic triple therapy.     

Eradication of Helicobacter pylori can facilitate immune reconstitution in HIV-1-infected immunological non-responders

ObjectiveA significant number of HIV-1 patients experience poor immune reconstitution despite long-term viral suppression with highly active antiretroviral therapy (immunological non-responders). The aims of the present study were to determine whether eradication of Helicobacter pylori could facilitate a better immune reconstitution in these patients.MethodsForty-nine immunological non-responder HIV-1 patients were evaluated by ¹³C-urea breath test (UBT) for the presence of active H. pylori infection. They were all asymptomatic. The UBT was positive in 26 (53%) of them. Eleven patients (group 1) were treated with a combination of omeprazole 20 mg bid, amoxicillin 1 g bid and clarithromycin 500 mg bid for 14 consecutive days. Eight weeks later, successful eradication was proven by a repeat negative UBT in all 11 patients. The remaining 15 (group 2) refused the H. pylori eradication treatment. All 26 patients were followed for 24 months and evaluated for blood CD4 and CD8 cell counts and percentages and for plasma HIV-1 viral load.ResultsAt the time of H. pylori diagnosis and eradication (baseline), CD4 and CD8 cell counts were similar in both study groups. All 11 H. pylori eradicated patients (group 1) had a significant increase in CD4 cell count starting 3 months and peaking 12–18 months after H. pylori eradication. Thereafter, CD4 levels gradually declined. Nevertheless, 24 months after triple therapy it was significantly higher than prior to H. pylori eradication. Parallel reciprocal changes were observed in CD8 cell counts. There were no significant changes in either CD4 or CD8 cell counts in group 2 patients. None of the patients of group 1 demonstrated virological failure, while four (26.7%) group 2 patients experienced virological failure requiring change of highly active antiretroviral therapy (HAART) regimen.ConclusionTriple therapy for H. pylori eradication is associated with a significant, although possibly transient immune reconstitution in HAART-treated HIV-1 patients with viral suppression without immunological response.     

Efficacy of Helicobacter pylori eradication therapy in chronic liver disease

Background/aimsPeptic ulcers occur more commonly in patients with liver cirrhosis (LC). Helicobacter pylori is recognized as the most important etiology in the pathogenesis of peptic ulcers. We investigated the efficacy of proton pump inhibitor (PPI)-based triple therapy in patients with chronic liver disease and peptic ulcer.Patients and methodsOne hundred sixty-three patients with LC or chronic hepatitis (CH) with a peptic ulcer and proven H. pylori infection were included. The combination of PPI, amoxicillin (1.0 g), and clarithromycin (500 mg), each given twice daily, was administered for 1 or 2 weeks. The eradication of H. pylori was determined by the rapid urease test, histology, or the ¹³C-urea breath test at least 4 weeks after completing the treatment.ResultsThe eradication rate of H. pylori was similar between the LC and CH groups; 82.6% and 88.1%, respectively. In addition, there were no significant differences in eradication rates between the patients with Child-Pugh class A and Child-Pugh class B/C disease. The side effects in each group were generally mild. Only the serum ALT levels showed a significant correlation with the success of H. pylori eradication in both the LC and CH groups.ConclusionThe PPI-based triple therapy achieves high eradication rates for H. pylori infection, in patients with chronic liver disease, without significant side effects.     

Efficacy of H. pylori eradication with a sequential regimen followed by rescue therapy in clinical practice

BackgroundCurrent Italian guidelines suggest sequential therapy as first-line therapy and a levofloxacin-based rescue therapy for Helicobacter pylori eradication. We evaluated the efficacy of these therapies in clinical practice.Methods84 consecutive patients with dyspeptic symptoms and proven H. pylori infection by either UBT or upper endoscopy with biopsies were enrolled. Patients received a 10-day sequential therapy with lansoprazole 30 mg plus amoxycillin 1 g (all twice daily) for the first 5 days, followed by lansoprazole 30 mg, clarithromycin 500 mg, and metronidazole 500 mg (all twice daily) for the remaining 5 days. Eradication failure patients received triple therapy with lansoprazole 30 mg, levofloxacin 250 mg, and amoxycillin 1 g (all twice daily) for 10 days.ResultsFollowing the sequential therapy H. pylori eradication was achieved in 70/84 (83.3%; 95% CI = 75.4–91.3) patients, and in 70/77 (90.9%; 95% CI = 84.5–97.3) patients at ITT and PP analyses, respectively. The infection was cured in all 7 eradication failure patients by using second-line therapy.ConclusionsA sequential regimen as first-line therapy and a 10-day levofloxacin-based triple regimen in those patients who failed to clear the infection, appear to be a valid therapeutic strategy for management of H. pylori infection in clinical practice.     

Efficacy of quadruple therapy for Helicobacter pylori eradication after failure of proton pump inhibitor‐based triple therapy in Singapore

BACKGROUND: Helicobacter pylori eradication is the mainstay in the treatment of H. pylori‐associated peptic ulcer disease. Current standard eradication therapy consists of 1 week of treatment with a proton pump inhibitor (PPI) and two antibiotics selected from amoxicillin, metronidazole and clarithromycin. In this study we aimed to assess the efficacy of quadruple therapy consisting of a PPI, bismuth, tetra‐cycline and metronidazole in patients for whom initial H. pylori eradication using a triple therapy regimen consisting of a PPI, amoxicillin and clarithromycin was unsuccessful. METHODS: Consecutive patients with H. pylori‐associated peptic ulcer disease, in whom H. pylori with triple therapy had been unsuccessful, were included in the study. These patients had been treated with a regimen that included a PPI (standard dose twice daily), amoxicillin (1 g twice daily) and clarithro­mycin (500 mg twice daily) for 1 week during 1997?2001. Diagnosis of peptic ulcer disease was made at esophagogastroduodenoscopy. Helicobacter pylori infection was considered to be present on the basis of either a positive rapid urease test, positive histo­logical identification of H. pylori or both. Failure of initial H. pylori eradication was established with either a rapid urease test, a ¹³C urea breath test or histology. Quadruple therapy consisted of a PPI (standard dose twice daily), metronidazole (400 mg three times daily), tetracycline (500 mg four times daily) and bismuth subcitrate (240 mg twice daily). Failure of quadruple therapy was diagnosed on the basis of a positive ¹³C urea breath test. RESULTS: Fifty‐three patients received quadruple therapy. The median age was 52 years (range 20?74) and the male to female ratio was 42 : 11. On an intent‐to‐treat basis, the eradication rate was 69.8%, whereas on a per‐protocol basis, the eradication rate was 82.2%. CONCLUSION: We conclude that a 1‐week quadruple therapy regime consisting of a PPI, bismuth, tetracycline and metronidazole was effective in 82.2% of patients who experienced an unsuccessful initial H. pylori eradication attempt with PPI, amoxicillin and clarithromycin.     

Second-line levofloxacin-based triple schemes for Helicobacter pylori eradication

BackgroundThe recommended second-line therapy for Helicobacter pylori (H. pylori) eradication is a quadruple regimen that fails in up to 30% of patients. Several recent studies suggest levofloxacin-based triple therapies as an alternative rescue treatment. However, dosage and length of levofloxacin-based regimens have not been established.AimTo compare the efficacy and tolerability of four second-line levofloxacin-based schemes for H. pylori eradication.MethodsOne hundred and sixty patients (aged 18–70 years, 72 male patients) who were H. pylori positive after standard triple therapies were randomised to receive esomeprazole 20 mg b.d. and amoxicillin 1 g b.d. plus levofloxacin 500 mg o.d., for 7 or 10 days (Groups A and B) or levofloxacin 500 mg b.d. for 7 days or 10 days (Groups C and D). H. pylori status was assessed by 13-C Urea Breath Test or rapid urease test, before and 6 weeks after therapy. Incidence of side effects was evaluated by a questionnaire.ResultsNo dropouts were observed. Eradication of H. pylori infection was successful in: 65% of patients in Group A; 90% in Group B; 70% in Group C; 85% in Group D. Based upon duration of treatment, eradication rates were: 67.5% in 7 days groups and 87.5% in 10 days groups (p = 0.004). Dosage of levofloxacin did not affect the eradication rates (77.5% both in the once daily and twice daily groups).Mild adverse events were reported overall in 16% of patients (22.5% in 7 days groups; 27.5% in 10 days groups; p = 0.58; 12% in the once daily group; 32.5% in the twice daily group; p = 0.04).Conclusions10 days levofloxacin-based second-line regimens were effective in curing H. pylori infection in more than 85% of patients with a lower incidence of adverse effects in levofloxacin single-dosage scheme. The 10 days levofloxacin-based regimens were more effective than 7 days course of treatment showing that duration of therapy is the crucial factor affecting eradication rate.     

Comparison of Helicobacter pylori eradication rates of standard 14-day quadruple treatment and novel modified 10-day, 12-day and 14-day sequential treatments

Background & aimThis study aimed to compare the efficacy and safety of bismuth-included standard regimen and modified sequential treatments in Turkey, where the success rate of standard triple therapy is very low.MethodsOne-hundred and sixty patients with dyspeptic complaints and naïve Helicobacter pylori infection were randomized into four groups: 41 patients received standard 14-day quadruple treatment (STD) (Rabeprazole 20 mg-bid, bismuth subcitrate (120 mg-qid), Tetracycline 500 mg-qid, Metronidazole 500 mg-tid) for 2 weeks. The modified sequential therapy groups received 20 mg rabeprazole and 1 g amoxicillin, twice daily for the first 5 days, followed by Rabeprazole 20 mg-bid, bismuth subcitrate (120 mg-qid), Tetracycline 500 mg-qid, Metronidazole 500 mg-tid for the remaining 5 (10 day sequential therapy group-10S) (42 patients), 7 (12 day sequential therapy group-12S) (42 patients) and 9 (14 day sequential therapy group-14S) (41 patients) days.ResultsThe overall compliance and H. pylori eradication rate among the 160 patients who completed the H. pylori eradication regimens were 86.9% (139/160) and 78.1% (125/160), respectively. The results were not statistically different between groups in the eradication rates. Per-protocol eradication rates were 76.5% in STD, 71.4% in 10S, 82.4% in 12S and 83.3% in 14S groups (p = 0.7). Intention-to-treatment rates were 77.5% in STD, 72.5% in 10S, 82.5% in 12S and 80.0% in 14S groups (p = 0.5).ConclusionThe eradication rates of standard 14-day and different sequential quadruple treatment regimens are comparable and much more higher than with standard 14-day triple H. pylori eradication treatment that has been reported previously in Turkey.     

Erradicación de Helicobacter pylori en México con un esquema basado en levofloxacina versus la triple terapia estándar: resultados de un estudio clínico de fase iiib,abierto, aleatorizado,de no inferioridad

Introduction and aimsHelicobacter pylori (H. pylori) infection remains the leading cause of several gastroduodenal diseases. Despite the fact that multiple antibiotic regimens have been used to change its associated morbidity and mortality, the prevalence of this bacterial infection continues to be disproportionately high worldwide, mainly due to antibiotic resistance. To assess the noninferiority efficacy and safety of 2 10-day triple regimens on H. pylori eradication, we evaluated clarithromycin 500 mg, lansoprazole 30 mg, and amoxicillin 1 g, all bid (standard triple therapy or CLA, Group 1) vs. pantoprazole 80 mg, levofloxacin 500 mg and azithromycin 500 mg, all od (PLA, Group 2). Both regimens were compared in treatment-naïve patients.Materials and methodsAn open label phase IIIb randomized and noninferiority trial comparing CLA vs. PLA was carried out for a 10-day period, within the time frame of June 2012 and March 2014. Eradication was verified with ¹³C-urea breath testing. Gastric biopsies were tested for fluorescence in situ hybridization (FISH)-clarithromycin resistance prior to any antibiotic administration. Efficacy and safety results were analyzed according to the noninferiority methodological approach.ResultsFrom the 227 H. pylori positive subjects that were randomized, 194 were finally analyzed as per-protocol. The group 2 eradication rate was 63% and was noninferior to the group 1 eradication rate of 58.5% (upper limit 95% CI: 0.11608; below the noninferiority margin: 0.1200). FISH clarithromycin-resistance was found in 28.2% of the cases. Adverse events, all minor and self-limited, were significantly higher in group 1 than in group 2 (86 vs. 65.4%; p = 0.001).ConclusionsFirst-line H. pylori eradication with pantoprazole/levofloxacin/azithromycin combination therapy is as effective as the standard triple therapy, with better tolerability and easier dosing. Clarithromycin resistance should be considered when selecting antibiotics in Helicobacter pylori eradication treatments.ClinicalTrials.gov identifier NCT02726269.     

Erradicación de la infección por Helicobacter pylori con una nueva terapia cuádruple basada en bismuto en la práctica clínica

Introduction

The eradication of Helicobacter pylori infection represents a clinical challenge.

Efficacy of PPI,levofloxacin and amoxicillin in the eradication of Helicobacter pylori compared to conventional triple therapy at a Venezuelan hospital

Background and study aimsHelicobacter pylori is the main cause of gastritis, gastroduodenal ulcers and gastric cancer. In the past two decades, the recommended treatment for its eradication as a first-line regimen is the standard triple therapy consisting of a proton pump inhibitor (PPI), amoxicillin and clarithromycin or metronidazole. However, the effectiveness of this traditional regime, which initially was 90%, progressively declined in many parts of the world and is currently 57–73%. The aim of this study was to evaluate whether the eradication rate with triple therapy with levofloxacin is superior as first-line therapy to that with treatment using clarithromycin in the population that attended as outpatients at the Hospital of Lídice.Patients and methodsWe designed a prospective study, with two groups of patients presenting dyspeptic symptoms, from October 2010 to October 2011, who underwent upper gastrointestinal endoscopy and whose biopsies were positive for infection with H. pylori. At the end, 81 patients were included in the order of biopsy result arrival to fill the quota of each group. The first group with 42 patients underwent triple therapy with clarithromycin and the second group with 39 patients underwent therapy with levofloxacin, amoxicillin and a PPI. The patients’ age ranged between 23 and 76 years, the average being 49.5. The predominant sex was female, at 72.84%. Both treatments lasted for 10 days and the patients were clinically re-evaluated 15 days after their conclusion and programmed for a second endoscopy to verify H. pylori eradication.ResultsAmong the 42 patients in the control group, there were 14 eradication failures with 33.33% resistance to clarithromycin. Among the 39 patients in the experimental group, two eradication failures with 5.13% resistance to levofloxacin were observed. The χ² value was 6.96.ConclusionsTreatment with levofloxacin was more effective than conventional triple therapy. Triple therapy with levofloxacin can be implemented in populations where resistance to clarithromycin has been observed.     

The efficacy of a 1-week triple therapy for eradication of Helicobacter pylori infection in children

Background and study aimsPoor compliance to therapy and antibiotic resistance are the main causes for failure of anti-Helicobacter pylori (H. pylori) therapy. The purpose of this study was to assess the effectiveness of omeprazole-based triple therapy in Iranian children.Patients and methodsFifty-seven children with H. pylori-related gastroduodenal disease received 1-week triple therapy with a combination of omeprazole, amoxicillin and clarithromycin (according to the susceptibility test). Success of eradication was assessed by ¹³C-urea breath test and endoscopy.ResultsSixty-four patients (mean age 11.3 years; range 2.7–16 years) were included. Eradication was successful in 84.2% (95% confidence interval, 72.8% intention to treat).ConclusionOne-week triple therapy was effective for the eradication of H. pylori infection in children.     

An optimized clarithromycin-free 14-day triple therapy for Helicobacter pylori eradication achieves high cure rates in Uruguay

Background

Strong acid inhibition increases cure rates with triple therapy and 14-day are more effective than 7-day treatments. The combination of amoxicillin plus metronidazole at full doses has been shown to overcome metronidazole resistance and to achieve good eradication rates even in patients harboring resistant strains. No previous studies have been reported in Latin-America with this optimized triple-therapy scheme.

Helicobacter pylori first-line treatment and rescue option containing levofloxacin in patients allergic to penicillin

AimTo assess the efficacy and tolerability of Helicobacter pylori first-line treatment (omeprazole–clarithromycin–metronidazole) and second-line rescue option (omeprazole–clarithromycin–levofloxacin) in patients allergic to penicillin.MethodsPatients: Prospective multicenter study including consecutive patients allergic to penicillin. Therapy regimens: First-line treatment (50 patients): Omeprazole (20 mg b.i.d.), clarithromycin (500 mg b.i.d.) and metronidazole (500 mg b.i.d.) for 7 days. Second-line treatment (15 therapy failures out of the aforementioned 50 patients): Omeprazole (20 mg b.i.d.), clarithromycin (500 mg b.i.d.) and levofloxacin (500 mg b.i.d.) for 10 days. Outcome variable: Negative ¹³C-urea breath test 8 weeks after completion of treatment.Results(1) First-line treatment (omeprazole–clarithromycin–metronidazole): Per-protocol and intention-to-treat eradication rates were 55% (27/49; 95%CI = 40–70%) and 54% (27/50; 95%CI = 39–69%). Compliance with treatment and follow-up was complete in 98% of cases (one patient was not compliant due to nausea). Adverse events were reported in 5 patients (10%): 4 nausea, 1 diarrhoea. (2) Second-line treatment (omeprazole–clarithromycin–levofloxacin): Per-protocol and intention-to-treat eradication rates were both 73% (11/15; 95%CI = 45–92%). Compliance with treatment and follow-up was complete in all the cases. Adverse events were reported in 4 patients (20%), which did not prevent the completion of treatment: Mild nausea (2 patients), and vomiting and myalgias/arthralgias (1 patient).ConclusionIn H. pylori infected patients allergic to penicillin, the generally recommended first-line treatment with omeprazole, clarithromycin and metronidazole has low efficacy for curing the infection. On the other hand, a levofloxacin-containing regimen (together with omeprazole and clarithromycin) represents an encouraging second-line alternative in the presence of penicillin allergy.     

Efficacy and safety of rifaximin associated with standard triple therapy (omeprazole,clarithromycin and amoxicillin) for H. pylori eradication: A phase IV pilot clinical trial

Background

A progressive decrease in Helicobacter pylori eradication rates has been described over the years, driving the need for new antibiotic treatments.

Quadruple,sequential, and concomitant first-line therapies for H. pylori eradication: a prospective,randomized study

BackgroundCurrent Italian guidelines recommend 10-day bismuth-based or bismuth-free (sequential and concomitant) regimens for first-line H. pylori eradication. However, comparison among these regimens is lacking in our country.AimTo perform a ‘head-to-head’ comparison among these three therapies as first-line treatment for H. pylori eradication in clinical practice.MethodsThis was a prospective, open-label randomized study enrolling consecutive patients diagnosed with H. pylori infection never previously treated. Patients were randomized to receive one of the following 10-day therapies: (a) Bismuth-based therapy: esomeprazole 20 mg b.i.d and Pylera 3 tablets q.i.d; (b) Concomitant therapy: esomeprazole 20 mg plus amoxicyllin 1,000 mg, clarithromycin 500 mg and tinidazole 500 mg (all b.i.d.), and (c) Sequential therapy: esomeprazole 20 mg plus amoxicyllin 1,000 mg for 5 days followed by esomeprazole 20 mg plus clarithromycin 500 mg and tinidazole 500 mg for 5 days (all b.i.d). H. pylori eradication was assessed by using UBT 4-6 weeks after the end of therapy.ResultsOverall, 187 patients were enrolled. The eradication rates achieved with Pylera, concomitant and sequential were 85.2%, 95.2%, and 93.6%, respectively, at intention to treat, and 94.5%, 96.7%, and 95.1% at per protocol analyses, without a statistically significant difference. The incidence of severe side-effects was higher with the bismuth-based therapy than with the two bismuth-free regimens (9.8% vs 1.6%; p = 0.046).ConclusionsBismuth-based and bismuth-free therapies are equally effective for first-line H. pylori eradication. However, bismuth therapy was more frequently interrupted for side-effects than bismuth-free therapies.