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- W2034353566 abstract "Clarithromycin-resistant Helicobacter pylori has become a problem in many countries and there is considerable interest in finding new treatment regimens that can be used without culture and sensitivity testing in routine clinical practice.1 A combination of three anti-microbials with a proton pump inhibitor (PPI), commonly referred to as quadruple therapy, is a well-established therapy for H. pylori infection, and has been shown in some randomized controlled trials to be superior to triple therapy.2 A number of anti-microbials have been used in quadruple therapy and include: (i) bismuth, metronidazole and tetracycline, (ii) metronidazole, tetracycline and amoxicillin and (iii) amoxicillin, clarithromycin and metronidazole. In these studies, the combination of three anti-microbials and a PPI has been better than triple therapy (a combination of two anti-microbials and a PPI). A review has shown that increasing the degree of acid suppression with high-dose PPI therapy may improve eradication rates with triple therapy.3 Similarly, attempts to lengthen duration of triple therapy, from 7 or 10 days to 14 days, has been proposed as a way to improve the results of eradication therapy.4 The study by Molina-Infante et al. is interesting because it compares prolonged (14 days), high-dose PPI (esomeprazole 40 mg twice a day) triple therapy with clarithromycin and amoxicillin, to the same regimen with the addition of another anti-microbial (metronidazole) creating a 14-day, high-dose, prolonged PPI quadruple therapy. The study demonstrated that the eradication rate improves by 10% with the quadruple regimen and just reaches the critical threshold of 90% that an ideal treatment regimen should achieve.5 In the ultimate analysis, this and other recent studies show the poor outcomes with traditional therapies. Increasing the duration of treatment, adding another anti-microbial to triple therapy and increasing the dose of PPIs, improves the results of treatment. In the future, we need new anti-microbials to treat the growing problem of resistance in H. pylori. Declaration of personal interests: Consultant: Astra Zeneca, Baxter, Ironwood. Declaration of funding interests: None." @default.
- W2034353566 created "2016-06-24" @default.
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- W2034353566 date "2015-03-04" @default.
- W2034353566 modified "2023-09-26" @default.
- W2034353566 title "Editorial: quadruple therapy forH. pylorieradication is better than triple therapy" @default.
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- W2034353566 doi "https://doi.org/10.1111/apt.13107" @default.
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