Affecting Eradication Rate Research Articles

S1331 Antibiotic Resistance Rates in Helicobacter pylori Infection Derived from Retrospective Cure Rates

INTRODUCTION: Current guidelines and consensus recommendations call for tailoring the treatment of Helicobacter pylori (H. pylori) to local antibiotic resistance patterns as resistance rates, particularly to clarithromycin, are increasing. However, knowledge of community resistance is uncommon because traditional culture and susceptibility testing is rarely performed. Thus, we aimed to evaluate susceptibility patterns based on eradication rates obtained from the electronic health record (EHR). METHODS: We performed a retrospective cohort study of all adult outpatients diagnosed with H. pylori at a single large tertiary care referral center between 6/1/2016 and 6/30/2018. Patient demographic data including age, sex, race, initial and confirmatory test modalities were extracted from the EHR. Factors associated with resistance were also collected, including clinic practice type, body mass index (BMI), history of diabetes, tobacco and alcohol use, prior antibiotic exposure, and H. pylori-directed antimicrobial regimens. Chi-square and Wilcoxon rank sum tests were used to assess associations between outcome and treatment regimen. RESULTS: There were 1,711 patients diagnosed with H. pylori during the study period and 622 (36%) underwent eradication testing. The cure rate among those with confirmatory testing was 90%, with stool antigen serving as the most common eradication test modality (N = 320, 51%). Comparing those with confirmed versus failed eradication, there were no significant differences by sex (P = 0.86), race (P = 0.44), or age (P = 0.16), respectively. Among treated patients, most (N = 392, 79%) received triple therapy and there was no significant difference in cure rates compared to those receiving quadruple therapy (P = 0.35). Additionally, the presence of clarithromycin in a regimen did not significantly affect eradication rates compared to those who received another regimen (90% versus 86%, respectively; P = 0.65). CONCLUSION: The H. pylori eradication rate among those tested was high, with no significant differences between studied regimens or evaluated factors. Importantly, clarithromycin resistance appears low within our local population. These findings indicate the feasibility of using data obtained from the EHR to track local H. pylori resistance patterns and highlight how knowledge of local antimicrobial resistance can guide therapy.Table 1.: Patient statistics by treatment outcomeFigure 1.: H. pylori eradication rates did not vary significantly (P = 0.65) by treatment regimen. The overall cure rate was 90% and clarithromycin-based regimens did not have a lower cure rate compared to other studied regimens. Abbr: Amox = amoxicillin, Clarith = clarithromycin, Tetra = tetracycline, Metro = metronidazole, PPI = proton pump inhibitor.

Helicobacter pylori eradication rate of standard triple therapy and factors affecting eradication rate at Bahir Dar city administration, Northwest Ethiopia: A prospective follow up study.

BackgroundEradication of Helicobacter pylori infection with standard triple therapy has been accepted to curb associated risks of chronic gastritis andpeptic ulcer disease.ObjectiveTo assess H. pylori eradication rate of standard triple therapy and patient related factors affecting eradication rate.MethodsA facility based prospective follow up study was conducted in Bahir Dar City Administration, Ethiopia, on consented outpatients presented with gastritis and peptic ulcer disease and positive for H. pylori stool antigen test from May 2016 to April 2018. Eradication was confirmed with stool antigen test made after 4–6 weeks of standard triple therapy, comprising of proton pump inhibitor, clarithromycin and amoxicillin. Pre-developed questionnaire and data collection formats were used to collect variables before and after therapy. Bivariate and backward stepwise multivariate logistic regression was used to analyze data. P-value < 0.05 at 95%CI was considered as significant.ResultsThe overall H. pylori eradication rate was 90.3% (379/421). Almost 80% of the patients were urban residents. Mean (±SD) age and body weight of patients were 30.63 (± 10.74) years and 56.79 (± 10.17) kg, respectively. Self-reported adverse drug effects and area of residence of patients were factors affecting eradication rate significantly. Patients with no self-reported adverse drug effect were 3.85 (AOR: 3.85; 95%CI (1.41–5.26)) times more likely to eradicate H. pylori infection compared to those reported adverse effects. Patients living in rural area were 2.7 (AOR: 2.7; 95%CI (1.19–20.0)) times more likely to achieve eradication compared to urban residents.ConclusionH. pylori eradication rate is within the recommended level for clinical practice, indicating that modifications of the standard triple therapy observed in the different healthcare institutions are not evidence-based. Emphasis should be given to adverse drug effects of medications and tailored counseling based on area of residence could have a contribution in improving eradication rate.

Helicobacter pylori eradication in patients with type 2 diabetes mellitus: Multicenter prospective observational study.

Objective:To compare Helicobacter pylori (H. pylori) eradication rate of type 2 diabetic patients with non-diabetic subjects.Methods:In this multicenter prospective observational study, H. pylori-infected subjects were enrolled from three university-affiliated hospitals. Eradication regimen was triple therapy with standard dose of proton pump inhibitors (b.i.d), amoxicillin (1.0 g b.i.d), and clarithromycin (500 mg b.i.d) for 7 days. Urea breath test was performed 4 weeks after treatment. Various clinical and laboratory data were collected for identification of factors associated with successful eradication.Results:Totally, 144 subjects were enrolled and 119 (85 non-diabetic and 34 diabetic patients) were finally analyzed. Eradication rate was 75.6% and there was no difference between diabetic patients and non-diabetic subjects (73.5% vs 76.5%, p value: 0.814). Adverse drug reactions were reported in 44.5% of patients. In multivariate analysis for predicting H. pylori eradication in diabetic patients, HbA1c (⩾7.5%) was a significant factor affecting eradication rate (adjusted odds ratio: 0.100, 95% confidence interval: 0.011–0.909, p value: 0.041).Conclusion:Diabetes itself is not a major factor affecting H. pylori eradication. However, poor glucose control may harmfully affect H. pylori eradication.

An Additive Effect of Oral N-Acetyl Cysteine on Eradication of Helicobacter pylori.

Background. Helicobacter pylori is highly adapted to the gastric environment where it lives within or beneath the gastric mucous layer. The aim of this study was to evaluate whether the addition of N-acetyl cysteine to the treatment regimen of H. pylori infection would affect eradication rates of the disease. Methods. A total of 79 H. pylori positive patients were randomized to two therapeutic groups. Both groups received a 14-day course of three-drug regimen including amoxicillin/clarithromycin/omeprazole. Experimental group (38 subjects) received NAC, and control group (41 subjects) received placebo, besides three-drug regimen. H. pylori eradication was evaluated by urea breath test at least 4 weeks after the cessation of therapy. Results. The rate of H. pylori eradication was 72.9% and 60.9% in experimental and control groups, respectively (P = 0.005). By logistic regression modeling, female gender (OR 3.68, 95% CI: 1.06–5.79; P = 0.040) and treatment including NAC (OR 1.88, 95% CI: 0.68–3.15; P = 0.021) were independent factors associated with H. pylori eradication. Conclusion. The results of the present study show that NAC has an additive effect on the eradication rates of H. pylori obtained with three-drug regimen and appears to be a promising means of eradicating H. pylori infection.

Helicobacter Pylori Therapy in Children: Overview and Challenges

Helicobacter pylori is one of the most common infections found in humans. It was first identified in 1982 and by 1989 had been associated with gastric inflammation and ulcers in adults and children. During the 1990's evidence emerged of its etiologic role in stomach cancers in adults. That the infection is common and may have serious consequences, has led to an avalanche of research during the last twenty years. During this time, there have been many studies on children which have sought an effective and safe treatment to eradicate the infection, but as yet, no therapy regimen has been found which is always effective and safe. This article provides information, from a pediatric point of view, on the major developments in the therapeutics and therapy of H. pylori infection. It examines first-line treatment regimens, evaluates the efficacy of the main drugs used in the management of (primary) H. pylori infection in children, assesses the potential for the use of probiotics and sequential therapy, examines therapeutic options after failure of initial treatment, and discusses factors affecting eradication rate, including antibiotic resistance, adherence to therapy, and bacterial factors.

Sequential Therapy for Helicobacter Pylori: A Two for One Deal That's Worth the Extra Effort?

Sequential Therapy for Helicobacter Pylori: A Two for One Deal That's Worth the Extra Effort?

Second-line levofloxacin-based triple schemes for Helicobacter pylori eradication

The recommended second-line therapy for Helicobacter pylori (H. pylori) eradication is a quadruple regimen that fails in up to 30% of patients. Several recent studies suggest levofloxacin-based triple therapies as an alternative rescue treatment. However, dosage and length of levofloxacin-based regimens have not been established. To compare the efficacy and tolerability of four second-line levofloxacin-based schemes for H. pylori eradication. One hundred and sixty patients (aged 18-70 years, 72 male patients) who were H. pylori positive after standard triple therapies were randomised to receive esomeprazole 20mg b.d. and amoxicillin 1g b.d. plus levofloxacin 500 mg o.d., for 7 or 10 days (Groups A and B) or levofloxacin 500 mg b.d. for 7 days or 10 days (Groups C and D). H. pylori status was assessed by 13-C Urea Breath Test or rapid urease test, before and 6 weeks after therapy. Incidence of side effects was evaluated by a questionnaire. No dropouts were observed. Eradication of H. pylori infection was successful in: 65% of patients in Group A; 90% in Group B; 70% in Group C; 85% in Group D. Based upon duration of treatment, eradication rates were: 67.5% in 7 days groups and 87.5% in 10 days groups (p=0.004). Dosage of levofloxacin did not affect the eradication rates (77.5% both in the once daily and twice daily groups). Mild adverse events were reported overall in 16% of patients (22.5% in 7 days groups; 27.5% in 10 days groups; p=0.58; 12% in the once daily group; 32.5% in the twice daily group; p=0.04). 10 days levofloxacin-based second-line regimens were effective in curing H. pylori infection in more than 85% of patients with a lower incidence of adverse effects in levofloxacin single-dosage scheme. The 10 days levofloxacin-based regimens were more effective than 7 days course of treatment showing that duration of therapy is the crucial factor affecting eradication rate.

Efficacy of a Low-Dose Omeprazole-Based Triple-Therapy Regimen for Helicobacter pylori Eradication Independent of Cytochrome P450 Genotype

To investigate the efficacies of two different triple-therapy regimens (standard versus low doses), and the influence of cytochrome P450 enzyme (CYP) genetic polymorphism on these efficacies, in Japanese patients undergoing Helicobacter pylori eradication treatment. All patients received 1 week of triple therapy. Patients in group A (low-dose regimen) received omeprazole 40 mg/day + amoxicillin 1500 mg/day + clarithromycin 800 mg/day; patients in group B (standard-dose regimen) received omeprazole 40 mg/day + amoxicillin 2000 mg/day + clarithromycin 1000 mg/day. A total of 225 patients (113 in group A and 112 in group B) were randomised to one of the two triple-therapy regimens. The eradication rates were 78.8% (89/113 patients; 95% CI 70.1, 85.9) in group A and 83.0% (93/112 patients; 95% CI 74.8, 89.5) in group B. Genetic polymorphism of CYP2C19, a major metabolic enzyme of omeprazole, did not affect eradication rates, while susceptibility to clarithromycin greatly affected the success of eradication. The cumulative ulcer relapse rate at 24 weeks after endoscopically documented ulcer healing (30 weeks after completion of the drug regimen) was 8.3% for group A and 12.5% for group B (log rank test: p = 0.6248). However, comparison of the cumulative relapse rate of 6.7% in patients after successful H. pylori eradication with the relapse rate of 27.3% in those who failed H. pylori eradication revealed a significant difference in the remission-time curve (log rank test: p = 0.0047). This finding suggested the existence of a relationship between H. pylori eradication failure and ulcer relapse. Both drug regimens were well tolerated. Endoscopically proven reflux esophagitis developed in about 10% of patients after eradication, but was not clinically significant. One week of triple therapy with a low-dose regimen provides adequate H. pylori eradication in Japanese patients. CYP genetic polymorphism is of minimal clinical significance with both triple-therapy regimens.

Density of Helicobacter pylori (Hp) organisms does not affect eradication rates in peptic ulcer disease (PUD) and non-peptic ulcer disease (NPUD)

Density of Helicobacter pylori (Hp) organisms does not affect eradication rates in peptic ulcer disease (PUD) and non-peptic ulcer disease (NPUD)