7 research outputs found
Sequential Metronidazole-Furazolidone or Clarithromycin-Furazolidone Compared to Clarithromycin-Based Quadruple Regimens for the Eradication of Helicobacter pylori in Peptic Ulcer Disease: A Double-Blind Randomized Controlled Trial
Background: Furazolidone is a much cheaper drug with a very low resistance against Helicobacter pylori compared to clarithromycin. We aim to evaluate safety and efficacy of a sequential furazolidone-based regimen versus clarithromycin-based therapy in H. pylori eradication for ulcer disease.Materials: Patients with proven peptic ulcer or duodenitis were randomized into three groups: OAB-M-F; metronidazole (M) (500 mg bid) for the first 5 days, followed by furazolidone (F) (200 mg bid) for the second 5 days; OAC-P; clarithromycin (C) (500 mg bid) for 10 days; and OAB-C-F; clarithromycin (500 mg bid) for the first 5 days and furazolidone (200 mg bid) for the second 5 days. All groups received omeprazole (O) (20 mg bid) and amoxicillin (A) (1 g bid). Groups OAB-M-F and OAB-C-F were also given bismuth subcitrate (B) (240 mg bid), whereas a placebo (P) was given to group OAC-P. Adverse events were scored and recorded. Two months after treatment, a C13-urea breath test was performed.Results: Three hundred and ten patients were enrolled and 92 (OAB-M-F), 95 (OAC-P), and 98 (OAB-C-F) completed the study. The intention-to-treat eradication rates were 78.5 (95 CI = 69-85), 81.1 (95 CI = 73-88), and 82 (95 CI = 74-89), and per-protocol eradication rates were 91.3 (95 CI = 83-96), 90.4 (95 CI = 82-95), and 88.7 (95 CI = 81-94), for group OAB-M-F, OAC-P, and OAB-C-F, respectively. Eradication rate differences did not reach statistical significance. The most common adverse event, bad taste, occurred in all groups, but more frequently in groups OAC-P (34) and OAB-C-F (32), than OAB-M-F (14) (p<.05). Adverse symptoms score were 0.88 ± 2.05 in group OAB-M-F, 1.15 ± 1.40 in group OAC-P, and 1.87 ± 1.62 in group OAB-C-F.Conclusion: Furazolidone can replace clarithromycin in H. pylori eradication regimens because of lack of development of resistance and very low cost. © 2010 Blackwell Publishing Ltd
Eradication of H. pylori Infection: the Challenge is on if Standard Therapy Fails
The recommended standard triple therapy for Helicobacter pylori infection,
consisting of a proton pump inhibitor, clarithromycin and amoxicillin or
metronidazole, can reach eradication rates in over 90%. However, in recent years
resistance to antibiotics has increased and eradication rates have declined.
Approximately one in five patients need a second-line therapy because
eradication therapy fails. Second-line treatment with a bismuth-based quadruple
therapy leads to satisfactory eradication rates, but bismuth is not available in
many countries. Modern second- and third-line treatments can only be successful
if they are adapted to the current resistance situation and they need to evolve
continuously. Moreover, pharmacodynamic effects due to polymorphisms of the
cytochrome P450 system are important. Because therapy adherence is significantly
associated with therapy success, modern regimens if possible should be easy to
take and well tolerated. In recent years, various novel salvage-therapy regimens
have been investigated that significantly improve treatment options
Second-Line Rescue Therapy of Helicobacter Pylori Infection
Helicobacter pylori infection is the main known cause of gastritis,
gastroduodenal ulcer disease and gastric cancer. After more than 20 years of
experience in H. pylori treatment, however, the ideal regimen
to treat this infection has still to be found. Nowadays, apart from having to
know well first-line eradication regimens, we must also be prepared to face
treatment failures. Therefore, in designing a treatment strategy we should not
focus on the results of primary therapy alone, but also on the final (overall)
eradication rate. The choice of a ‘rescue’ treatment
depends on which treatment is used initially. If a first-line
clarithromycin-based regimen was used, a second-line metronidazole-based
treatment (quadruple therapy) may be used afterwards, and then a
levofloxacin-based combination would be a third-line
‘rescue’ option. Alternatively, it has recently been
suggested that levofloxacin-based ‘rescue’ therapy
constitutes an encouraging second-line strategy, representing an alternative to
quadruple therapy in patients with previous PPI-clarithromycin-amoxicillin
failure, with the advantage of efficacy, simplicity and safety. In this case,
quadruple regimen may be reserved as a third-line ‘rescue’
option. Finally, rifabutin-based ‘rescue’ therapy
constitutes an encouraging empirical fourth-line strategy after multiple
previous eradication failures with key antibiotics such as amoxicillin,
clarithromycin, metronidazole, tetracycline, and levofloxacin. Even after two
consecutive failures, several studies have demonstrated that H.
pylori eradication can finally be achieved in almost all patients if
several ‘rescue’ therapies are consecutively given.
Therefore, the attitude in H. pylori eradication therapy
failure, even after two or more unsuccessful attempts, should be to fight and
not to surrender