Update on non-bismuth quadruple (concomitant) therapy for eradication of Helicobacter pylori

Background: Traditional standard triple therapy for Helicobacter pylori (H. pylori) infection (proton pump inhibitor-clarithromycin-amoxicillin) can easily be converted to non-bismuth quadruple (concomitant) therapy by the addition of a nitroimidazole twice daily. Aim: To critically review evidence...

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Autores: P. Gisbert, Javier|||0000-0003-2090-3445, Calvet, Xavier|||0000-0002-6278-9663
Tipo de recurso: artículo
Fecha de publicación:2012
País:España
Institución:Universitat Autònoma de Barcelona
Repositorio:Dipòsit Digital de Documents de la UAB
Idioma:inglés
OAI Identifier:oai:ddd.uab.cat:204073
Acceso en línea:https://ddd.uab.cat/record/204073
https://dx.doi.org/urn:doi:10.2147/CEG.S25419
Access Level:acceso abierto
Palabra clave:Clarithromycin
Concomitant therapy
Helicobacter pylori
Metronidazole
Non-bismuth quadruple
Sequential therapy
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spelling Update on non-bismuth quadruple (concomitant) therapy for eradication of Helicobacter pyloriP. Gisbert, Javier|||0000-0003-2090-3445Calvet, Xavier|||0000-0002-6278-9663ClarithromycinConcomitant therapyHelicobacter pyloriMetronidazoleNon-bismuth quadrupleSequential therapyBackground: Traditional standard triple therapy for Helicobacter pylori (H. pylori) infection (proton pump inhibitor-clarithromycin-amoxicillin) can easily be converted to non-bismuth quadruple (concomitant) therapy by the addition of a nitroimidazole twice daily. Aim: To critically review evidence on the role of non-bismuth quadruple therapy (proton pump inhibitor-clarithromycin-amoxicillin-nitroimidazole) in the treatment of H. pylori infection. Methods: Bibliographical searches were performed in MEDLINE and relevant congresses up to December 2011. We performed a meta-analysis of the studies evaluating the concomitant therapy, and of the randomized controlled trials comparing the concomitant and the standard triple therapy. Results: A meta-analysis of 19 studies (2070 patients) revealed a mean H. pylori cure rate (intention-to-treat) of 88% (95% confidence interval from 85% to 91%) for non-bismuth quadruple therapy. We performed a meta-analysis of the randomized controlled studies comparing the concomitant (481 patients) and the standard triple therapy (503 patients). The formerwas more effective than the latter: 90% versus 78% (intention-to-treat analysis). Results were homogeneous (I = 0%). The odds ratio for this comparison was 2.36 (95% confidence interval from 1.67 to 3.34). A tendency toward better results with longer treatments (7-10 days versus 3-5 days) has been observed, so it seems reasonable to recommend the length of treatment achieving the highest cure rates (10 days). Clarithromycin resistance may reduce the efficacy of non-bismuth quadruple therapy, although the decrease in eradication rates seems to be farlower than in standard triple therapy. Experience with the non-bismuth quadruple therapy in patients with metronidazole-resistant strains is still very limited. Conclusion: Non-bismuth quadruple (concomitant) therapy appears to be an effective, safe, and well-tolerated alternative to triple therapy and is less complex than sequential therapy. Therefore, this regimen appears well suited for use in settings where the efficacy of triple therapy is unacceptably low. 22012-01-0120122012-01-01Articlehttp://purl.org/coar/resource_type/c_6501VoRhttp://purl.org/coar/version/c_970fb48d4fbd8a85info:eu-repo/semantics/articleapplication/pdfhttps://ddd.uab.cat/record/204073https://dx.doi.org/urn:doi:10.2147/CEG.S25419reponame:Dipòsit Digital de Documents de la UABinstname:Universitat Autònoma de BarcelonaInglésengopen accesshttp://purl.org/coar/access_right/c_abf2Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original.https://creativecommons.org/licenses/by-nc/4.0/info:eu-repo/semantics/openAccessoai:ddd.uab.cat:2040732026-06-06T12:50:31Z
dc.title.none.fl_str_mv Update on non-bismuth quadruple (concomitant) therapy for eradication of Helicobacter pylori
title Update on non-bismuth quadruple (concomitant) therapy for eradication of Helicobacter pylori
spellingShingle Update on non-bismuth quadruple (concomitant) therapy for eradication of Helicobacter pylori
P. Gisbert, Javier|||0000-0003-2090-3445
Clarithromycin
Concomitant therapy
Helicobacter pylori
Metronidazole
Non-bismuth quadruple
Sequential therapy
title_short Update on non-bismuth quadruple (concomitant) therapy for eradication of Helicobacter pylori
title_full Update on non-bismuth quadruple (concomitant) therapy for eradication of Helicobacter pylori
title_fullStr Update on non-bismuth quadruple (concomitant) therapy for eradication of Helicobacter pylori
title_full_unstemmed Update on non-bismuth quadruple (concomitant) therapy for eradication of Helicobacter pylori
title_sort Update on non-bismuth quadruple (concomitant) therapy for eradication of Helicobacter pylori
dc.creator.none.fl_str_mv P. Gisbert, Javier|||0000-0003-2090-3445
Calvet, Xavier|||0000-0002-6278-9663
author P. Gisbert, Javier|||0000-0003-2090-3445
author_facet P. Gisbert, Javier|||0000-0003-2090-3445
Calvet, Xavier|||0000-0002-6278-9663
author_role author
author2 Calvet, Xavier|||0000-0002-6278-9663
author2_role author
dc.subject.none.fl_str_mv Clarithromycin
Concomitant therapy
Helicobacter pylori
Metronidazole
Non-bismuth quadruple
Sequential therapy
topic Clarithromycin
Concomitant therapy
Helicobacter pylori
Metronidazole
Non-bismuth quadruple
Sequential therapy
description Background: Traditional standard triple therapy for Helicobacter pylori (H. pylori) infection (proton pump inhibitor-clarithromycin-amoxicillin) can easily be converted to non-bismuth quadruple (concomitant) therapy by the addition of a nitroimidazole twice daily. Aim: To critically review evidence on the role of non-bismuth quadruple therapy (proton pump inhibitor-clarithromycin-amoxicillin-nitroimidazole) in the treatment of H. pylori infection. Methods: Bibliographical searches were performed in MEDLINE and relevant congresses up to December 2011. We performed a meta-analysis of the studies evaluating the concomitant therapy, and of the randomized controlled trials comparing the concomitant and the standard triple therapy. Results: A meta-analysis of 19 studies (2070 patients) revealed a mean H. pylori cure rate (intention-to-treat) of 88% (95% confidence interval from 85% to 91%) for non-bismuth quadruple therapy. We performed a meta-analysis of the randomized controlled studies comparing the concomitant (481 patients) and the standard triple therapy (503 patients). The formerwas more effective than the latter: 90% versus 78% (intention-to-treat analysis). Results were homogeneous (I = 0%). The odds ratio for this comparison was 2.36 (95% confidence interval from 1.67 to 3.34). A tendency toward better results with longer treatments (7-10 days versus 3-5 days) has been observed, so it seems reasonable to recommend the length of treatment achieving the highest cure rates (10 days). Clarithromycin resistance may reduce the efficacy of non-bismuth quadruple therapy, although the decrease in eradication rates seems to be farlower than in standard triple therapy. Experience with the non-bismuth quadruple therapy in patients with metronidazole-resistant strains is still very limited. Conclusion: Non-bismuth quadruple (concomitant) therapy appears to be an effective, safe, and well-tolerated alternative to triple therapy and is less complex than sequential therapy. Therefore, this regimen appears well suited for use in settings where the efficacy of triple therapy is unacceptably low.
publishDate 2012
dc.date.none.fl_str_mv 2
2012-01-01
2012
2012-01-01
dc.type.none.fl_str_mv Article
http://purl.org/coar/resource_type/c_6501
VoR
http://purl.org/coar/version/c_970fb48d4fbd8a85
dc.type.openaire.fl_str_mv info:eu-repo/semantics/article
format article
dc.identifier.none.fl_str_mv https://ddd.uab.cat/record/204073
https://dx.doi.org/urn:doi:10.2147/CEG.S25419
url https://ddd.uab.cat/record/204073
https://dx.doi.org/urn:doi:10.2147/CEG.S25419
dc.language.none.fl_str_mv Inglés
eng
language_invalid_str_mv Inglés
language eng
dc.rights.none.fl_str_mv open access
http://purl.org/coar/access_right/c_abf2
https://creativecommons.org/licenses/by-nc/4.0/
dc.rights.openaire.fl_str_mv info:eu-repo/semantics/openAccess
rights_invalid_str_mv open access
http://purl.org/coar/access_right/c_abf2
https://creativecommons.org/licenses/by-nc/4.0/
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.source.none.fl_str_mv reponame:Dipòsit Digital de Documents de la UAB
instname:Universitat Autònoma de Barcelona
instname_str Universitat Autònoma de Barcelona
reponame_str Dipòsit Digital de Documents de la UAB
collection Dipòsit Digital de Documents de la UAB
repository.name.fl_str_mv
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