Two-week bismuth-containing quadruple therapy and concomitant therapy are effective first-line treatments for Helicobacter pylori eradication: A prospective open-label randomized trial

BACKGROUND Increasing levels of antibiotic resistance have reduced the Helicobacter pylori(H.pylori)eradication rates afforded by the standard triple therapy.Thus,2-wk firstline four-drug regimens must be considered.AIM To analyze the eradication rates of modified bismuth-containing quadruple therapy(mBCQT)and concomitant therapy(CT),the associated adverse events,and compliance.METHODS Patients infected with H.pylori were prospectively randomized to receive mBCQT or CT for 2 wk.mBCQT featured a proton pump inhibitor(PPI),bismuth,metronidazole,and tetracycline,taken twice daily.CT included a PPI,clarithromycin,metronidazole,and amoxicillin,taken twice daily.The 13C-urea breath test was performed no earlier than 4 wk after therapy concluded to confirm eradication.If either the histological or rapid urease test was positive,H.pylori infection was diagnosed.RESULTS The demographic characteristics of 68 patients who received mBCQT and 68 who received CT did not differ significantly.On intention-to-treat analysis,the eradication rate was 88.2%(60/68)in the mBCQT group and 79.4%(54/68)in the CT group(P=0.162).By per-protocol analysis,the respective eradication rates were 98.4%(60/61)and 93.1%(54/58)(P=0.199).More CT than mBCQT patients experienced adverse events[33.8%(23/68)mBCQT vs 51.5%(35/58)CT patients,respectively,P=0.037].All patients showed good compliance[85.3%(58/68)mBCQT vs 82.4%(56/68)CT patients,P=0.641].CONCLUSION The H.pylori eradication rates of the 2-wk mBCQT and CT regimens are high.Most patients show good compliance,and more CT than mBCQT patients experience adverse events.

A new look at anti-Helicobacter pylori therapy

With the rising prevalence of antimicrobial resistance,the treatment success of standard triple therapy has recently declined to unacceptable levels (i.e.,80% or less) in most countries.Therefore,several treatment regimens have emerged to cure Helicobacter pylori (H.pylori) infection.Novel first-line anti-H.pylori therapies in 2011 include sequential therapy,concomitant quadruple therapy,hybrid (dual-concomitant) therapy and bismuth-containing quadruple therapy.After the failure of standard triple therapy,a bismuth-containing quadruple therapy comprising a proton pump inhibitor (PPI),bismuth,tetracycline and metronidazole can be employed as rescue treatment.Recently,triple therapy combining a PPI,levofloxacin and amoxicillin has been proposed as an alternative to the standard rescue therapy.This salvage regimen can achieve a higher eradication rate than bismuth-containing quadruple therapy in some regions and has less adverse effects.The best second-line therapy for patients who fail to eradicate H.pylori with first-line therapies containing clarithromycin,amoxicillin and metronidazole is unclear.However,a levofloxacin-based triple therapy is an accepted rescue treatment.Most guidelines suggest that patients requiring third-line therapy should be referred to a medical center and treated according to the antibiotic susceptibility test.Nonetheless,an empirical therapy (such as levofloxacin-based or furazolidone-based therapies) can be employed to terminate H.pylori infection if antimicrobial sensitivity data are unavailable.

Helicobacter pylori:Future perspectives in therapy reflecting three decades of experience

The rising prevalence of antibiotic resistance has created a need to reassess the established Helicobacter pylori(H.pylori)eradication protocols,and to develop new ones.Various bacterial and host factors are evaluated,and their contribution to eradication failure is estimated.For a long time being considered the cornerstone eradication scheme,the standard triple therapy has been replaced with novel,more efficient regimens,namely sequential and concomitant,along with the emergence of a new design of bismuth quadruple therapy.A rescue levofloxacin based regimen has overcome the fear of therapy failure due to higher prevalence of dual resistant(clarithromycin and metronidazole)H.pylori.Culture-free and efficient susceptibility test are reestablishing the concept of tailored therapy,making eradication success close to originally desirable rates.Alleviating therapy side effects and improving patient compliance are as important as choosing appropriate eradication schemes,so various probiotic compound supplements are taken into consideration.Finally,we summarize the emerging efforts and obstacles in creating efficientH.pylori vaccine.

A review of Helicobacter pylori diagnosis, treatment, and methods to detect eradication

Helicobacter pylori (H. pylori) affects nearly half of the world’s population and, thus, is one of the most frequent and persistent bacterial infections worldwide. H. pylori is associated with peptic ulcer disease, gastric ulcers, mucosa-associated lymphoid tissue lymphoma, and gastric cancer. Various diagnostic methods exist to detect infection, and the choice of one method or another depends on several factors, such as accessibility, advantages and disadvantages of each method, cost, and the age of patients. Once H. pylori infection is diagnosed, the clinician decides whether treatment is necessity, according to the patient’s clinical condition. Typically, eradication of H. pylori is recommended for treatment and prevention of the infection. Cure rates with the standard triple therapy are acceptable, and effective quadruple therapies, sequential therapies, and concomitant therapies have been introduced as key alternatives to treat H. pylori infection. In this work, we review the main diagnostic methods used to identify H. pylori infection and to confirm eradication of infection. In addition, key factors related to treatment are reviewed.

Optimal treatment strategy for Helicobacter pylori:Era of antibiotic resistance

Standard triple therapy, consisting of a proton pump inhibitor, plus amoxicillin and clarithromycin, has been the most commonly used first-line treatment regimen for Helicobacter pylori (H. pylori) eradication for many years worldwide. However, as a result of increased resistance to antibiotics, H. pylori eradication rates with use of standard triple therapy have been declining and recently reached < 80% in many countries. Several new strategies to enhance the eradication rate of H. pylori have been studied. Currently, among the alternative first-line eradication regimens, concomitant and hybrid regimens have shown excellent results and could be the optimal treatment option. Although clinical usefulness of rescue therapy for patients in whom eradication of H. pylori with non-bismuth quadruple regimen has failed is unclear, levofloxacin-based quadruple therapy has shown promise as a rescue treatment. The choice of third-line therapy depends on factors such as the local pattern of antibiotic resistance, drug availability, and previous treatment. We hope that a simple method for detection of antibiotic susceptibility using polymerase chain reaction would be a possible alternative to administration of “tailored treatment” in the era of increasing prevalence of antimicrobial resistance.

Eradication of Helicobacter pylori infection:Which regimen first?

Helicobacter pylori (H. pylori) is a well-known human pathogen that plays an essential role in the pathogenesis of chronic gastritis, peptic ulcer disease, and gastric malignancies. Although H. pylori is susceptible to several antimicrobials, this infection has proven challenging to cure because of the increasing prevalence of bacterial strains that are resistant to the most commonly used antimicrobials, particularly clarithromycin. An effective (i.e., > 90%) first-line therapy is mandatory for avoiding supplementary treatments and testing, and more importantly for preventing the development of secondary resistance. This study reviews the recent literature on first-line therapies for H. pylori. The eradication rates following standard triple therapy (a proton pump inhibitor plus amoxicillin and clarithromycin) for H. pylori infection are declining worldwide. Several first-line strategies have been proposed to increase the eradication rate, including extending the treatment duration to 14 d, the use of a four-drug regimen (bismuth-containing quadruple, sequential, and concomitant treatments), and the use of novel antibiotics, such as fluoroquinolones. However, the efficacy of these regimens is controversial. A first-line eradication regimen should be based on what works best in a defined geographical area and must take into account the prevalence of antimicrobial resistance in that region.

Current Helicobacter pylori treatment in 2014

Helicobacter pylori is one of the most commonly seen bacterium worldwide.It's in the etiology of multiple gastrointestinal diseases,ranging from gastritis to gastric carcinoma.The antimicrobial therapies,which are frequently prescribed empirically,are losing their effectivity as a result of the increasing antimicrobial resistance.As the standard triple therapy is now leftespecially in areas with high-clarithromycin resistance due to decreased eradication rates,quadruple therapies are recommended in most regions of the world.Alternatively,concomitant,sequential and hybrid therapies are used.There is still a debate going on about the use of levofloxacin-based therapy in order to prevent the increase in quinolone resistance.If no regimen can achieve the desired eradication rate,culture-guided individualized therapies are highly recommended.Probiotics,statins and n-acetylcysteine are helpful as adjuvant therapies in order to increase the effectiveness of the eradication therapy.Herein,we focused on different eradication regimens in order to highlight the current Helicobacter pylori treatment.

Assessing of the Therapeutic Efficacy of These 2 Treatment Regimens in the Management of Helicobacter pylori Infection at Kinshasa

Introduction: Helicobacter pylori (Hp) infection is a worldwide public health problem. Unfortunately, its management poses a problem because of resistance to antibiotics. However, there are codified treatment protocols covering sequential and concomitant quadritherapy with regard to first-line probabilistic treatment. The objective of this study was to assess the therapeutic efficacy of these 2 treatment regimens in the management of Hp infection at Kinshasa. Methods: This was a mixed study, with documentary, descriptive and interventional approaches, carried out between September 1, 2018 and April 30, 2020. Results: Sixty-four patients were collected, including 36 men against 28 women with a sex ratio of 1H:1F;the mean age was 54 ± 16.5 years. There was an over-representation of senior patients (n = 29);an intermediate number of adult patients (n = 22) and a lower number of young patients (n = 13). 34 and 30 were respectively treated according to the concomitant and sequential regimens. Concomitant quadruple therapy offered an eradication rate of 91.2% compared to 56.7% for sequential quadruple therapy;concomitant treatment, advancing age and absence of risky behavior more quickly predicted the occurrence of eradication success. Conclusion: The present study showed superiority of concomitant quadruple therapy over sequential quadruple therapy in first-line treatment. Alcohol with active smoking had a negative influence, while concomitant quadruple therapy, advancement in age had a positive influence on the success of the eradication of Hp infection.

The effect of treatment package time in head and neck cancer patients treated with adjuvant radiotherapy and concurrent systemic therapy

Objectives:In patients with head and neck carcinoma,“treatment package time”(TPT)was proven to impact outcomes in cases receiving adjuvant radiotherapy alone.Its impact in patients receiving radiotherapy with concurrent systemic therapy has not been studied previously.The TPT influence on survival endpoints for patients treated with surgery followed by radiation and concurrent systemic therapy was analyzed.Methods:Institutional database to identify head and neck carcinoma cases treated with definitive surgery followed by concomitant chemo(bio)radiotherapy(CRT)was used.TPT was the number of days elapsed between surgery and the last day of radiation.%FINDCUT SAS macro tool was used to search for the cutoff TPT that was associated with significant survival benefit.Kaplan-Meier curves,log-rank tests as well as univariate and multivariate analyses were used to assess overall survival(OS)and recurrence free survival(RFS).Results:One hundred and three cases with a median follow up of 37 months were included in the study.Oropharyngeal tumors were 43%,oral cavity 40%and laryngeal 17%of cases.Concurrent systemic therapy included platinum and cetuximab in 72%and 28%,respectively.Optimal TPT was found to be<100 days with significantly better OS(P=0.002)and RFS(P=0.043)compared to TPT≥100 days.On multivariate analysis;TPT<100 days,extracapsular nodal extension,high-risk score,iymphovascular space and perineural invasion were independent predictors for worse OS(P<0.05).T4,extracapsular nodal extension and high-risk score were all significantly detrimental to RFS(P<0.05).Conclusions:Addition of concomitant systemic therapy to adjuvant radiotherapy did not compensate for longer TPT in head and neck squamous cell carcinoma.Multidisciplinary coordinated care must be provided to ensure the early start of CRT with minimal treatment breaks.