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Javier P Gisbert - One of the best experts on this subject based on the ideXlab platform.
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helicobacter pylori first line and rescue treatments in the presence of penicillin allergy
Digestive Diseases and Sciences, 2015Co-Authors: Javier P Gisbert, Javier Molinainfante, Jesus Barrio, Ines Modolell, Angeles Perez Aisa, Manuel Castrofernandez, Luis Rodrigo, Angel Cosme, Jose Luis Gisbert, Miguel FernandezbermejoAbstract:Helicobacter pylori eradication is a challenge in penicillin allergy. To assess the efficacy and safety of first-line and rescue treatments in patients allergic to penicillin. Prospective multicenter study. Patients allergic to penicillin were given a first-line treatment comprising (a) 7-day omeprazole–Clarithromycin–metronidazole and (b) 10-day omeprazole–bismuth–tetracycline–metronidazole. Rescue treatments were as follows: (a) bismuth quadruple therapy; (b) 10-day PPI–Clarithromycin–levofloxacin; and (c) 10-day PPI–Clarithromycin–rifabutin. Eradication was confirmed by 13C-urea breath test. Compliance was determined through questioning and recovery of empty medication envelopes. Adverse effects were evaluated by questionnaires. In total, 267 consecutive treatments were included. (1) First-line treatment: Per-protocol and intention-to-treat eradication rates with omeprazole–Clarithromycin–metronidazole were 59 % (62/105; 95 % CI 49–62 %) and 57 % (64/112; 95 % CI 47–67 %). Respective figures for PPI–bismuth–tetracycline–metronidazole were 75 % (37/49; 95 % CI 62–89 %) and 74 % (37/50; 95 % CI (61–87 %) (p < 0.05). Compliance with treatment was 94 and 98 %, respectively. Adverse events were reported in 14 % with both regimens (all mild). (2) Second-line treatment: Intention-to-treat eradication rate with omeprazole–Clarithromycin–levofloxacin was 64 % both after triple and quadruple failure; compliance was 88–100 %, with 23–29 % adverse effects (all mild). (3) Third-/fourth-line treatment: Intention-to-treat eradication rate with PPI–Clarithromycin–rifabutin was 22 %. In allergic to penicillin patients, a first-line treatment with a bismuth-containing quadruple therapy (PPI–bismuth–tetracycline–metronidazole) seems to be a better option than the triple PPI–Clarithromycin–metronidazole regimen. A levofloxacin-based regimen (together with a PPI and Clarithromycin) represents a second-line rescue option in the presence of penicillin allergy.
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nonbismuth quadruple concomitant therapy empirical and tailored efficacy versus standard triple therapy for Clarithromycin susceptible helicobacter pylori and versus sequential therapy for Clarithromycin resistant strains
Helicobacter, 2012Co-Authors: Javier Molinainfante, Carmen Pazospacheco, Gema Vinagrerodriguez, Belen Perezgallardo, Carmen Duenassadornil, Moises Hernandezalonso, G Gonzalezgarcia, Jose Maria Mateosrodriguez, M Fernandezbermejo, Javier P GisbertAbstract:Background: Using quadruple Clarithromycin-containing regimens for Helicobacter pylori eradication is controversial with high rates of macrolide resistance. Aim: To evaluate antibiotic resistance rates and the efficacy of empirical and tailored nonbismuth quadruple (concomitant) therapy in a setting with cure rates <80% for triple and sequential therapies. Methods: 209 consecutive naive H. pylori-positive patients without susceptibility testing were empirically treated with 10-day concomitant therapy (proton pump inhibitors (PPI), amoxicillin 1 g, Clarithromycin 500 mg, and metronidazole 500 mg; all drugs b.i.d.). Simultaneously, 89 patients with positive H. pylori culture were randomized to receive triple versus concomitant therapy for Clarithromycin-susceptible H. pylori, and sequential versus concomitant therapy for Clarithromycin-resistant strains. Eradication was confirmed with 13C-urea breath test or histology 8 weeks after completion of treatment. Results: Per-protocol (PP) and intention-to-treat eradication rates after empirical concomitant therapy without susceptibility testing were 89% (95%CI:84–93%) and 87% (83–92%). Antibiotic resistance rates were: Clarithromycin, 20%; metronidazole, 34%; and both Clarithromycin and metronidazole, 10%. Regarding Clarithromycin-susceptible H. pylori, concomitant therapy was significantly better than triple therapy by per protocol [92% (82–100%) vs 74% (58–91%), p = 0.05] and by intention to treat [92% (82–100%) vs 70% (57–90%), p = 0.02]. As for antibiotic-resistant strains, eradication rates for concomitant and sequential therapies were 100% (5/5) vs 75% (3/4), for Clarithromycin-resistant/metronidazole-susceptible strains and 75% (3/4) vs 60% (3/5) for dual-resistant strains. Conclusions: Empirical 10-day concomitant therapy achieves good eradication rates, close to 90%, in settings with multiresistant H. pylori strains. Tailored concomitant therapy is significantly superior to triple therapy for Clarithromycin-susceptible H. pylori and at least as effective as sequential therapy for resistant strains.
C Omorain - One of the best experts on this subject based on the ideXlab platform.
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metronidazole resistance reduces efficacy of triple therapy and leads to secondary Clarithromycin resistance
Digestive Diseases and Sciences, 1997Co-Authors: Martin Buckley, Denise Hyde, C T Keane, C OmorainAbstract:There has been a significant increase in theprevalence of H. pylori resistance to metronidazole inrecent years, while Clarithromycin resistance is stillrelatively rare. In this study we assessed: (1) the effect of primary H. pylori resistance tometronidazole and Clarithromycin on the clinicalefficacy of a one-week regimen consisting of omeprazole,metronidazole, and Clarithromycin; and (2) the rate of acquisition of secondary antimicrobialresistance after treatment failure. Eighty-sevenpatients with duodenal ulceration or nonulcer dyspepsiawere included in the study. The primary metronidazoleand Clarithromycin resistance rates were 35.6% and3.4%, respectively (all three pretreatmentClarithromycin resistant strains had concurrentmetronidazole resistance). H. pylori was eradicated in81.6% of patients. The eradication rate for fullysensitive isolates was 98.2% (55/56) but wassignificantly reduced to 57.1% (16/28) for isolates thatwere resistant to metronidazole alone and 0% (0/3) incases of dual resistance (P < 0.001). Secondaryresistance to Clarithromycin was acquired in 58.3% ofcases of treatment failure. In areas of high prevalenceof primary metronidazole resistance, this is asignificant cause of treatment failure with this tripletherapy regimen. This leads to the selection of strainswith dual resistance that are difficult to eradicate andmay contribute to an increase in the prevalence of Clarithromycin resistance. In such areas analternative first-line treatment should beprescribed.
Javier Molinainfante - One of the best experts on this subject based on the ideXlab platform.
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helicobacter pylori first line and rescue treatments in the presence of penicillin allergy
Digestive Diseases and Sciences, 2015Co-Authors: Javier P Gisbert, Javier Molinainfante, Jesus Barrio, Ines Modolell, Angeles Perez Aisa, Manuel Castrofernandez, Luis Rodrigo, Angel Cosme, Jose Luis Gisbert, Miguel FernandezbermejoAbstract:Helicobacter pylori eradication is a challenge in penicillin allergy. To assess the efficacy and safety of first-line and rescue treatments in patients allergic to penicillin. Prospective multicenter study. Patients allergic to penicillin were given a first-line treatment comprising (a) 7-day omeprazole–Clarithromycin–metronidazole and (b) 10-day omeprazole–bismuth–tetracycline–metronidazole. Rescue treatments were as follows: (a) bismuth quadruple therapy; (b) 10-day PPI–Clarithromycin–levofloxacin; and (c) 10-day PPI–Clarithromycin–rifabutin. Eradication was confirmed by 13C-urea breath test. Compliance was determined through questioning and recovery of empty medication envelopes. Adverse effects were evaluated by questionnaires. In total, 267 consecutive treatments were included. (1) First-line treatment: Per-protocol and intention-to-treat eradication rates with omeprazole–Clarithromycin–metronidazole were 59 % (62/105; 95 % CI 49–62 %) and 57 % (64/112; 95 % CI 47–67 %). Respective figures for PPI–bismuth–tetracycline–metronidazole were 75 % (37/49; 95 % CI 62–89 %) and 74 % (37/50; 95 % CI (61–87 %) (p < 0.05). Compliance with treatment was 94 and 98 %, respectively. Adverse events were reported in 14 % with both regimens (all mild). (2) Second-line treatment: Intention-to-treat eradication rate with omeprazole–Clarithromycin–levofloxacin was 64 % both after triple and quadruple failure; compliance was 88–100 %, with 23–29 % adverse effects (all mild). (3) Third-/fourth-line treatment: Intention-to-treat eradication rate with PPI–Clarithromycin–rifabutin was 22 %. In allergic to penicillin patients, a first-line treatment with a bismuth-containing quadruple therapy (PPI–bismuth–tetracycline–metronidazole) seems to be a better option than the triple PPI–Clarithromycin–metronidazole regimen. A levofloxacin-based regimen (together with a PPI and Clarithromycin) represents a second-line rescue option in the presence of penicillin allergy.
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nonbismuth quadruple concomitant therapy empirical and tailored efficacy versus standard triple therapy for Clarithromycin susceptible helicobacter pylori and versus sequential therapy for Clarithromycin resistant strains
Helicobacter, 2012Co-Authors: Javier Molinainfante, Carmen Pazospacheco, Gema Vinagrerodriguez, Belen Perezgallardo, Carmen Duenassadornil, Moises Hernandezalonso, G Gonzalezgarcia, Jose Maria Mateosrodriguez, M Fernandezbermejo, Javier P GisbertAbstract:Background: Using quadruple Clarithromycin-containing regimens for Helicobacter pylori eradication is controversial with high rates of macrolide resistance. Aim: To evaluate antibiotic resistance rates and the efficacy of empirical and tailored nonbismuth quadruple (concomitant) therapy in a setting with cure rates <80% for triple and sequential therapies. Methods: 209 consecutive naive H. pylori-positive patients without susceptibility testing were empirically treated with 10-day concomitant therapy (proton pump inhibitors (PPI), amoxicillin 1 g, Clarithromycin 500 mg, and metronidazole 500 mg; all drugs b.i.d.). Simultaneously, 89 patients with positive H. pylori culture were randomized to receive triple versus concomitant therapy for Clarithromycin-susceptible H. pylori, and sequential versus concomitant therapy for Clarithromycin-resistant strains. Eradication was confirmed with 13C-urea breath test or histology 8 weeks after completion of treatment. Results: Per-protocol (PP) and intention-to-treat eradication rates after empirical concomitant therapy without susceptibility testing were 89% (95%CI:84–93%) and 87% (83–92%). Antibiotic resistance rates were: Clarithromycin, 20%; metronidazole, 34%; and both Clarithromycin and metronidazole, 10%. Regarding Clarithromycin-susceptible H. pylori, concomitant therapy was significantly better than triple therapy by per protocol [92% (82–100%) vs 74% (58–91%), p = 0.05] and by intention to treat [92% (82–100%) vs 70% (57–90%), p = 0.02]. As for antibiotic-resistant strains, eradication rates for concomitant and sequential therapies were 100% (5/5) vs 75% (3/4), for Clarithromycin-resistant/metronidazole-susceptible strains and 75% (3/4) vs 60% (3/5) for dual-resistant strains. Conclusions: Empirical 10-day concomitant therapy achieves good eradication rates, close to 90%, in settings with multiresistant H. pylori strains. Tailored concomitant therapy is significantly superior to triple therapy for Clarithromycin-susceptible H. pylori and at least as effective as sequential therapy for resistant strains.
Christoph Steininger - One of the best experts on this subject based on the ideXlab platform.
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Prevalence of Clarithromycin-resistant Helicobacter pylori strains in gastric mucosa-associated lymphoid tissue lymphoma patients
Annals of Hematology, 2016Co-Authors: Ceren Bilgilier, Ingrid Simonitsch-klupp, Barbara Kiesewetter, Markus Raderer, Werner Dolak, Athanasios Makristathis, Christoph SteiningerAbstract:Gastric MALT lymphoma is closely associated with Helicobacter pylori infection. Bacterial eradication therapy comprising Clarithromycin is the first-line treatment in gastric MALT lymphoma patients. However, antimicrobial resistance to Clarithromycin has been increasing in Europe, and thus far, it has not been examined in gastric MALT lymphoma patients. Based upon histopathological investigation, 17 adult gastric MALT lymphoma patients were identified to be related with H. pylori infection between 1997 and 2014. Detection of H. pylori infection in these patients and Clarithromycin susceptibility testing were performed by 23S rRNA gene real-time PCR. Twelve of the patients were confirmed with H. pylori infection by real-time PCR. Among these patients, only two were found to be infected with Clarithromycin-resistant H. pylori strain. In one of them, both the Clarithromycin-resistant and sensitive genotype were detected. The rate of Clarithromycin resistance was 15.4 %. Clarithromycin resistance pattern in gastric MALT lymphoma patients is under the predictions since a previous study performed in Central Europe revealed a rate of 36.6 % in Austria. Considering the low antimicrobial resistance rate, Clarithromycin is still an option in gastric MALT lymphoma management.
Dong H Kwon - One of the best experts on this subject based on the ideXlab platform.
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regional differences in metronidazole resistance and increasing Clarithromycin resistance among helicobacter pylori isolates from japan
Antimicrobial Agents and Chemotherapy, 2000Co-Authors: Mototsugu Kato, D Y Graham, Yoshio Yamaoka, Rita Reddy, Masahiro Asaka, Kei Kashima, Michael S Osato, Fouad A K Elzaatari, Dong H KwonAbstract:The patterns of antibiotic resistance in Helicobacter pylori were assessed in two different regions in Japan. Overall, prevalences of resistance to metronidazole and Clarithromycin were 12.4 and 12.9%, respectively. While there was no difference in Clarithromycin resistance, the prevalence of metronidazole resistance was significantly higher in Kyoto (23.8%) than in Sapporo (8.1%). From 1996 to 1999, the prevalence of metronidazole resistance did not change but the prevalence of Clarithromycin resistance doubled (from 9.1 to 18.7%).
