Most patients will be better served by first-line treatment with bismuth quadruple therapy or concomitant therapy consisting of a PPI Proton-pump inhibitors are a group of drugs whose main action is a pronounced and long-lasting reduction of stomach acid production. Within the class of medications, there is no clear evidence that one agent works better than another. Amoxicillin is used to treat a wide variety of bacterial infections.Proton-pump inhibitor
Amoxicillin
Which medications are used in the treatment of Helicobacter pylori (HP)?
Rifabutin-based high-dose proton-pump inhibitor and amoxicillin triple regimen as the rescue treatment for Helicobacter pylori. Helicobacter. 2014;19:455–461. doi: 10.1111/hel.12147. [PMC free article][PubMed] [CrossRef] [Google Scholar] 156.
Is Helicobacter pylori eradication possible in patients allergic to penicillin?
Background: Helicobacter pylori eradication is a challenge in patients allergic to penicillin, especially those who have failed a first-eradication trial. Aim: To assess the efficacy and tolerability of H. pylori first-line treatment and rescue options in patients allergic to penicillin.
Should patients already taking NSAIDs be tested for Helicobacter pylori infection?
The benefits of testing and treating H. pylori in patients already taking NSAIDs remains unclear (conditional recommendation, low quality of evidence). Patients with unexplained iron deficiency (ID) anemia despite an appropriate evaluation should be tested for H. pylori infection.
Do PPIs and antimicrobial agents work together to treat Helicobacter pylori?
A recent in vitrostudy also showed a synergistic effect of quinolone antimicrobial agents and PPIs on strains of H. pylori[Tanaka et al.2002].
What can I take instead of clarithromycin for H. pylori?
Quinolones (Levofloxacin/Moxifloxacin) as a Substitute for Clarithromycin in PPI Triple Therapies. The increasing prevalence of clarithromycin resistance as mentioned previously has prompted authors to incorporate levofloxacin in triple therapy.
Is H. pylori resistant to clarithromycin?
Conclusions. The prevalence of clarithromycin resistant H. pylori is low, but appears to be increasing. Point mutations in the 23S rRNA gene, mainly at the positions 2142 and 2143 with a transition of A→G, are responsible for the resistance.
Which of the following antibiotic is used for H. pylori infection?
pylori-caused ulcers are treated with a combination of antibiotics and an acid-reducing proton pump inhibitor. Antibiotics: Usually two antibiotics are prescribed. Among the common choices are amoxicillin, clarithromycin (Biaxin®), metronidazole (Flagyl®) and tetracycline.
What is the appropriate first-line treatment regimen for H. pylori infection?
A quinolone-containing triple therapy is effective as the first-line therapy for H pylori infection. Its cure rates range from 72 to 96% [52]. The regimen might be considered in populations with clarithromycin resistance greater than 15–20% and quinolone resistance less than 10% [53].
Is metronidazole good for H pylori?
pylori eradication rate (1). As the antimicrobial activity of metronidazole is marginally affected by low pH, this drug may be highly effective against H. pylori. The European Helicobacter Study Group has advised to employ a metronidazole-based triple therapy as choice in treating H.
What is triple therapy for H pylori?
Abstract. Background: Triple therapy (proton pump inhibitor, clarithromycin and amoxicillin or an imidazole) is the first-line treatment for Helicobacter pylori infection. However, the effectiveness of triple therapy is decreasing due to the increase in antibiotic resistance.
Does doxycycline treat H. pylori?
Minocycline/Doxycycline Tetracycline is one of the most frequently used secondline agents for the treatment of H. pylori infection.
Can levofloxacin treat H. pylori?
Bismuth + proton pump inhibitor (PPI) + amoxicillin + levofloxacin is one of the bismuth quadruple therapy regimens widely used for the eradication of H. pylori infection. The recommended dosage of levofloxacin is 500 mg once daily or 200 mg twice daily to eradicate H. pylori infection.
Can azithromycin treat H. pylori?
Azithromycin, a macrolide with a long term action [29, 30], is part of the assortment of drugs available for H. pylori treatment [31–34]. However, some studies have shown low eradication rates [35, 36]. In our country, a study has shown good efficacy of this antibiotic when associated with furazolidone [37].
How do you treat H. pylori if allergic to penicillin?
Conclusions: H. pylori-infected patients who are allergic to penicillin may be treated with a first-line treatment combining a proton-pump inhibitor, clarithromycin and metronidazole. Rescue options may include a regimen with ranitidine bismuth citrate, tetracycline and metronidazole.
Can omeprazole alone treat H. pylori?
Conclusions: Omeprazole is a well studied and well tolerated agent effective in adults or children as a component in regimens aimed at eradicating H. pylori infections or as monotherapy in the treatment and prophylaxis of GORD with or without oesophagitis or NSAID-induced gastrointestinal damage.
Which first-line therapy treatment is for H. pylori infections is no longer suitable for many regions?
Updated H. pylori therapy. With the rising prevalence of antimicrobial resistance, standard triple therapy is no longer effective in most countries [15,16,17].
What is the treatment for Helicobacter pylori?
Consequently, complete eradication is the goal of therapy. First-line therapy for H. pylori infection includes clarithromycin triple therapy (clarithromycin, ...
What is the first line of treatment for H. pylori?
First-line therapy for H. pylori infection includes clarithromycin triple therapy (clarithromycin, proton pump inhibitor [PPI], and amoxici …. Helicobacter pylori infection can lead to gastritis, gastric and duodenal ulcers, and gastric cancer. Consequently, complete eradication is the goal of therapy.
How long does it take for H pylori to be eradicated?
The cost of H. pylori eradication, which uses antibiotics and proton pump inhibitors (PPIs) for 7–14 days , was not significantly different between the treatment methods. The tailored therapy based on H. pylori susceptibility to antibiotics may be cost-effective in a high clarithromycin-resistant region compared to standard empirical triple therapy. There are reports that tailored treatment is superior in terms of cost-effectiveness if the eradication rate of H. pylori is lowered below 75.3%. Therefore, the tailored treatment based on H. pylori susceptibility to antibiotics was added to the recommendation. 20, 21
What is the unsuccessful eradication of Helicobacter?
Unsuccessful eradication is associated with high bacterial load, high gastric acidity, the virulence of Helicobacter strains and poor compliance. However, growing antibiotics resistance, particularly clarithromycin resistance seems to be the major cause of decreasing eradication rate. 9
What is the resistance rate for clarithromycin?
In the last 20 years, a widespread use of antibiotics, such as clarithromycin for respiratory symptoms and levofloxacin for urinary infection, has increased the primary H. pylori resistance in many countries. 10 Systematic review revealed that the overall H. pylori antibiotic resistance rates were 17.2% (95% confidence interval [CI], 16.5% to 17.9%) for clarithromycin, 26.7% (95% CI, 25.2% to 28.1%) for metronidazole, and 11.2% (95% CI, 9.6% to 12.7%) for amoxicillin. 10 Based on these changes, European guidelines recommended to extend the standard triple therapy to 14 days where clarithromycin resistance was >15%–20%. 11 In Korea, the clarithromycin resistance rates rose from 9% in 1995 and 13.8% in 2003 to 16.7% in 2005, and 17.8% in a nationwide study in 2018. 2, 12 - 14
Is H pylori a socioeconomic burden?
H. pylori is associated with socioeconomic burdens as it causes various gastro intestinal diseases and has a high prevalence rate of about 50% in Korea. It is clinically effective to establish therapeutic indications for H. pylori and to present effective primary and secondary treatment regimens; this is important and necessary for the efficient use of national medical resources. In recent years, as the resistance rate of H. pylori to clarithromycin has increased, the eradication rate of the existing standard triple therapy has tended to decrease. To overcome this, the treatment period has been extended or non-bismuth quadruple therapy such as sequential therapy or CT has been introduced. In the case of salvage therapy, it was difficult to select the right RCTs for each situation due to the diversity of first-line therapy regimens. As a result of meta-analyses of the latest RCTs published, bismuth quadruple therapy is recommended after standard triple therapy, sequential therapy, or CT has failed. If bismuth quadruple therapy is used as the first-line or salvage therapy, levofloxacin triple therapy is recommended. However, its effectiveness may be reduced in areas with high resistance to levofloxacin, such as Korea.
Does eradication of H. pylori improve dyspeptic symptoms?
In summary, eradication of H. pylori improved dyspeptic symptoms significantly, however, the clinical effect was not large due to the improvement of symptoms in 1 of 14 treated patients (NNT=14) and the result of subgroup analysis of RCTs conducted in Asia was not statistically significant. The prevalence of H. pylori in Korea is estimated to be 54% (95% CI, 50.1% to 57.8%) according to a study that estimates the prevalence of H. pylori worldwide. 59 In areas with high prevalence of H. pylori, costs, adverse effects associated with eradication therapy, the risk of emergence of resistance strains, and re-infection are thought to be higher than those of low prevalence regions. Therefore, in the present guideline, it was decided to make weak recommendations despite the high level of evidence for H. pylori eradication in patients with functional dyspepsia. The RCTs, including cost-effectiveness analysis of eradication therapy in patients with functional dyspepsia in areas with high prevalence of H. pylori, including in Korea, are likely to be needed.
Is H. pylori eradicated after EGC?
31 - 33 Thus, H. pylori should be eradicated to prevent metachronous recurrence after ER of EGC. However, there was no definite guideline about H. pylori eradication after ER of gastric adenoma. Until now, there were two RCTs about H. pylori eradication to prevent metachronous gastric cancer after ER of gastric tumors including EGC and adenoma ( Supplementary Table 1 ). 31 - 33 Three retrospective studies about H. pylori eradication after ER of gastric adenoma were reported. 34 - 36 All of them were conducted in Korea. According to studies, the incidence of metachronous recurrence was lower in H. pylori -eradicated group than non-eradicated group (3.24% vs 4.87% 33; 7.69% vs 14.29% 31; 7.76% vs 10.80% 34; 8.20% vs 19.44% 35; 4.71% vs 11.36% 36 ). When meta-analysis included five studies, the effect of H. pylori on prevention of metachronous recurrence after ER of gastric adenoma was statistically significant (OR, 0.55; 95% CI, 0.34 to 0.92) ( Fig. 2 ).
Is H. pylori a cause of gastric cancer?
It is the most common cause of gastric and duodenal ulcers and gastric cancer. Since the revision of the H. pylori clinical practice guidelines in 2013 in Korea, the eradication rate of H. pylori has gradually decreased with the use of a clarithromycin-based triple therapy for 7 days.
What is the first line of treatment for clarithromycin resistance?
The authors suggested that levofloxacin-containing sequential therapy is a therapy option as a first-line regimen in areas with clarithromycin resistance rates of more than 15%.
Is levofloxacin a triple therapy?
The increasing prevalence of clarithromycin resistance as mentioned previously has prompted authors to incorporate levofloxacin in triple therapy. The efficacy of levofloxacin-based triple therapy has been proven in a meta-analysis comparing this regimen with quadruple therapy as salvage therapy. The overall eradication rate with the levofloxacin regimen was 81 versus 70% with the quadruple combination (odds ratio: 1.80; 95% CI: 0.94–3.46). This meta-analysis also revealed fewer side effects and adverse events using levofloxacin-based triple therapy. In a recent crossover study, levofloxacin-based and clarithromycin-based triple therapies were compared as first- and second-line treatments for H. pylori infection. Clarithromycin-based triple therapy (PPI-AC) achieved a higher eradication rate than levofloxacin-based triple therapy (PPI-AL) as the first-line treatment (87.4% PPI-AC vs 80.1% PPI-AL). However, in patients who experienced failure with the standard triple as first-line therapy, PPI-AL was superior as the second-line therapy when compared with PPI-AC as second-line therapy. [ 31]
Is levofloxacin a substitute for clarithromycin?
In their trial, levofloxacin was applied as a substitute for clarithromycin in the known sequenti al therapy regimen . A total of 375 therapy-naive patients were included in the study and randomized to either 'classical' sequential therapy or sequential regimen containing levofloxacin instead of clarithromycin.
What is Helicobacter pylori?
Helicobacter pylori(H. pylori) infection is a common worldwide infection that is an important cause of peptic ulcer disease and gastric cancer. H. pylorimay also have a role in uninvestigated and functional dyspepsia, ulcer risk in patients taking low-dose aspirin or starting therapy with a non-steroidal anti-inflammatory medication, unexplained iron deficiency anemia, and idiopathic thrombocytopenic purpura. While choosing a treatment regimen forH. pylori, patients should be asked about previous antibiotic exposure and this information should be incorporated into the decision-making process. For first-line treatment, clarithromycin triple therapy should be confined to patients with no previous history of macrolide exposure who reside in areas where clarithromycin resistance amongstH. pyloriisolates is known to be low. Most patients will be better served by first-line treatment with bismuth quadruple therapy or concomitant therapy consisting of a PPI, clarithromycin, amoxicillin, and metronidazole. When first-line therapy fails, a salvage regimen should avoid antibiotics that were previously used. If a patient received a first-line treatment containing clarithromycin, bismuth quadruple therapy or levofloxacin salvage regimens are the preferred treatment options. If a patient received first-line bismuth quadruple therapy, clarithromycin or levofloxacin-containing salvage regimens are the preferred treatment options. Details regarding the drugs, doses and durations of the recommended and suggested first-line and salvage regimens can be found in the guideline.
What test is used to test for H. pylori?
pylori infection. Ideally, tests which identify active infection such as a urea breath test, fecal antigen test, or when endoscopy is performed, mucosal biopsy-based testing should be utilized.
How long does clarithromycin triple therapy last?
Both guidelines advocate for a longer duration of treatment (14 days for almost all regimens in the Toronto Consensus; 10–14 for almost all regimens in the ACG guideline). There are only a few differences between the two guidelines, occurring in areas with limited, low-quality evidence. The Toronto Consensus recommends against the use of sequential treatment (neither as a first-line therapy nor as a rescue treatment), while the ACG guideline conditionally recommends it as first-line therapy. Hybrid therapy and high-dose dual therapy are not officially endorsed by the Toronto Consensus, whereas the ACG guideline conditionally recommends them as first-line and rescue therapy respectively.
What is the most common chronic bacterial infection?
Helicobacter pylori infection remains one of the most common chronic bacterial infections affecting humans. Since publication of the last American College of Gastroenterology (ACG) Clinical Guideline in 2007, significant scientific advances have been made regarding the management of H. pylori infection. The most significant advances have been made in the arena of medical treatment. Thus, this guideline is intended to provide clinicians working in North America with updated recommendations on the treatment of H. pylori infection. For the purposes of this document, we have defined North America as the United States and Canada. Whenever possible, recommendations are based upon the best available evidence from the world’s literature with special attention paid to literature from North America. When evidence from North America was not available, recommendations were based upon data from international studies and expert consensus.
How long does bismuth quadruple therapy last?
The previous ACG guideline also endorsed the use of 10–14 days of bismuth quadruple therapy composed of a PPI or histamine-2 receptor antagonist, bismuth, metronidazole, and tetracycline. There is very limited data on the efficacy or comparative effectiveness of bismuth quadruple therapy in North America. A literature search identified only two RCTs which included a bismuth quadruple therapy arm ( n =172). The mean eradication rate with this regimen given for 10 days was 91% (95% CI; 81–98%).
Is clarithromycin a first line drug?
In current clinical practice in North America, it is uncommon for clarithromycin not to have been used first-line unless the patient had already been judged to have been at high risk for clarithromycin resistance. Theoretically, there is no evidence-based reason to avoid this regimen as a second-line treatment in such situations. That being said, the guideline committee recommends concomitant therapy over clarithromycin triple therapy when a clarithromycin containing salvage regimen is chosen.
Can a PUD be tested for H. pylori?
All patients with active peptic ulcer disease (PUD), a past history of PUD (unless previous cure of H. pylori infection has been documented), low-grade gastric mucosa-associated lymphoid tissue (MALT) lymphoma, or a history of endoscopic resection of early gastric cancer (EGC) should be tested for H. pylori infection. Those who test positive should be offered treatment for the infection (strong recommendation, quality of evidence: high for active or history of PUD, low for MALT lymphoma, low for history of endoscopic resection of EGC).