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The Influence of Omeprazole on the Dissolution Processes of pH-Dependent Magnetic Tablets Assessed by Pharmacomagnetography. Pharmaceutics 2021; 13:pharmaceutics13081274. [PMID: 34452233 PMCID: PMC8399305 DOI: 10.3390/pharmaceutics13081274] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 08/06/2021] [Accepted: 08/12/2021] [Indexed: 12/19/2022] Open
Abstract
Pharmacomagnetography involves the simultaneous assessment of solid dosage forms (SDFs) in the human gastrointestinal (GI) tract and the drug plasmatic concentration, using a biomagnetic technique and pharmacokinetics analysis. This multi-instrumental approach helps the evaluation, as GI variables can interfere with the drug delivery processes. This study aimed to employ pharmacomagnetography to evaluate the influence of omeprazole on the drug release and absorption of metronidazole administered orally in magnetic-coated tablets. Magnetic-coated tablets, coated with Eudragit® E-100 (E100) and containing 100 mg of metronidazole, were produced. For the in vivo experiments, 12 volunteers participated in the two phases of the study (placebo and omeprazole) on different days to assess the bioavailability of metronidazole. The results indicated a shift as the pH of the solution increased and a delay in the dissolution of metronidazole, showing that the pH increase interferes with the release processes of tablets coated with E100. Our study reinforced the advantages of pharmacomagnetography as a tool to perform a multi-instrumental correlation analysis of the disintegration process and the bioavailability of drugs.
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Murata M, Sugimoto M, Mizuno H, Kanno T, Satoh K. Clarithromycin Versus Metronidazole in First-Line Helicobacter Pylori Triple Eradication Therapy Based on Resistance to Antimicrobial Agents: Meta-Analysis. J Clin Med 2020; 9:jcm9020543. [PMID: 32079208 PMCID: PMC7073899 DOI: 10.3390/jcm9020543] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 02/09/2020] [Accepted: 02/12/2020] [Indexed: 02/08/2023] Open
Abstract
Background: International treatment guidelines for Helicobacter pylori infection recommend a proton pump inhibitor (PPI)/amoxicillin/clarithromycin (CAM) regimen (PAC) or PPI/amoxicillin/metronidazole (MNZ) regimen (PAM) as first-line therapy based on culture and sensitivity testing. As incidence rates of antimicrobial agent-resistant strains are changing year by year, it is important to reevaluate the efficacy of eradication regimens. We performed a meta-analysis to evaluate the efficacy and safety of PAC and PAM based on different locations categorized by the reported incidence of CAM- and MNZ-resistant strains. Methods: Randomized control trials (RCTs) comparing eradication rates between PAC and PAM first-line treatment up to December 2018 were included. We divided RCTs into four groups based on resistance to CAM (< 15% or ≥ 15%) and MNZ (< 15% or ≥ 15%). Results: A total of 27 studies (4825 patients) were included. Overall eradication rates between PAC and PAM were similar (74.8% and 72.5%, relative risk (RR): 1.13, 95% confidence interval (CI): 0.91–1.39, P = 0.27) in the intention-to-treat analysis. In areas with low MNZ- and high CAM-resistance rates, PAM had a significantly higher eradication rate than PAC (92.5% vs. 70.8%, RR: 0.29, 95% CI: 0.13–0.68). In areas with high MNZ- and low CAM-resistance rates, the eradication rate with PAC was only 72.9%. Conclusions: Overall eradication rates with PAC and PAM were equivalent worldwide. In low MNZ-resistance areas, PAM may be recommended as first-line therapy. However, the efficacy of PAC may be insufficient, irrespective of susceptibility to CAM.
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Affiliation(s)
- Masaki Murata
- Department of Gastroenterology, Shiga University of Medical Science Hospital, Otsu, Shiga 520-2192, Japan;
- Department of Gastroenterology, National Hospital Organization Kyoto Medical Center, Fushimi, Kyoto 612-8555, Japan
| | - Mitsushige Sugimoto
- Division of Digestive Endoscopy, Shiga University of Medical Science Hospital, Otsu, Shiga 520-2192, Japan
- Department of Gastroenterological Endoscopy, Tokyo Medical University Hospital, Shinjuku, Tokyo 160-0023, Japan
- Correspondence: ; Tel.: +81-3-3342-6111; Fax: +81-3-3345-5359
| | - Hitomi Mizuno
- Toyoda Aoba Clinic, Iwata, Shizuoka 438-0821, Japan;
| | - Takeshi Kanno
- Division of Gastroenterology, Tohoku University Hospital, Sendai, Miyagi 980-8578, Japan;
| | - Kiichi Satoh
- Department of Gastroenterology, International University of Health and Welfare Hospital, Nasushiobara, Tochigi 329-2763, Japan;
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Li B, Lan X, Wang L, Zhao J, Ding J, Ding H, Lei J, Wei Y, Zhang W. Proton-pump inhibitor and amoxicillin-based triple therapy containing clarithromycin versus metronidazole for Helicobacter pylori: A meta-analysis. Microb Pathog 2020; 142:104075. [PMID: 32074497 DOI: 10.1016/j.micpath.2020.104075] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 02/14/2020] [Accepted: 02/14/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Helicobacter pylori (H. pylori) infection is one of the important risk factors of gastric related diseases and antibiotic therapy has become an effective treatment. At present, proton-pump inhibitor and amoxicillin-based triple therapy, including clarithromycin (PAC) and metronidazole (PAM), are two commonly used first-line therapies for H. pylori infection, which has a high incidence and possibly poor prognosis worldwide. METHODS A systematic literature review was performed using the databases PubMed, the Cochrane Library, Ovid Medline, Science Direct, Embase, Scopus and Web of Science. Only randomized clinical trials with full texts published were included. RESULTS Eighteen studies involving 3264 patients were included. The pooled risk ratios (RR) between the PAC and PAM groups were comparable in the intention-to-treat (ITT) eradication rates (71.0% versus 75.2%, RR = 0.96, p = 0.38) and per-protocol (PP) eradication rates (79.6% versus 80.1%, RR = 1.02, p = 0.65). PAM is highly effective in clarithromycin-resistant cases (70.4% versus 48.2%, RR = 0.65, p = 0.002) and that PAC showed significant efficacy in metronidazole-resistant cases (87.3% versus 58.6%, RR = 1.43, p = 0.0006). In subgroup analysis, when using low-dose PPI, the PAM group showed greater efficacy than the PAC group. Furthermore, we found that PAM showed higher effectiveness in the studies published in recent years, especially for people over 60 years old (RR = 0.80, 95% CI: 0.71-0.89, p < 0.001). CONCLUSION In general, both PAC and PAM regimens were effective and comparable in eradicating H. pylori. However, the PAM regimen showed greater efficacy than the PAC regimen in recent years, especially for people over 60 years old.
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Affiliation(s)
- Bo Li
- Department of Thoracic Surgery, The Second Affiliated Hospital of Nanchang University, 330006, Nanchang, China; Jiangxi Medical College, Nanchang University, 330006, Nanchang, China
| | - Xiaoqian Lan
- Jiangxi Medical College, Nanchang University, 330006, Nanchang, China; Department of Gastroenterology, The Second Affiliated Hospital of Nanchang University, 330006, Nanchang, China
| | - Li Wang
- Jiangxi Medical College, Nanchang University, 330006, Nanchang, China; Department of Gastroenterology, The Second Affiliated Hospital of Nanchang University, 330006, Nanchang, China
| | - Jiani Zhao
- Jiangxi Medical College, Nanchang University, 330006, Nanchang, China; Department of Gastroenterology, The Second Affiliated Hospital of Nanchang University, 330006, Nanchang, China
| | - Jingli Ding
- Department of Gastroenterology, The Second Affiliated Hospital of Nanchang University, 330006, Nanchang, China
| | - Hao Ding
- Department of Gastroenterology, The Second Affiliated Hospital of Nanchang University, 330006, Nanchang, China
| | - Jun Lei
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Nanchang University, 330006, Nanchang, China
| | - Yiping Wei
- Department of Thoracic Surgery, The Second Affiliated Hospital of Nanchang University, 330006, Nanchang, China
| | - Wenxiong Zhang
- Department of Thoracic Surgery, The Second Affiliated Hospital of Nanchang University, 330006, Nanchang, China.
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Gebeyehu E, Nigatu D, Engidawork E. Self-reported adverse drug effects and associated factors among H. pylori infected patients on standard triple therapy: Prospective follow up study. PLoS One 2019; 14:e0225585. [PMID: 31756217 PMCID: PMC6874330 DOI: 10.1371/journal.pone.0225585] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 11/07/2019] [Indexed: 12/27/2022] Open
Abstract
Background One of the most common reasons for poor medication adherence and associated treatment failure of triple therapy is adverse drug effect (ADEs) of medications. Objective Assessment of ADEs and associated factors during H. pylori eradication therapy. Method Consented H. pylori positive adult outpatients on standard triple therapy (proton pump inhibitor, amoxicillin and clarithromycin) were involved in this facility based follow up study from May 2016 to April 2018 at Bahir Dar city in Ethiopia. Pre-developed questionnaire and formats were used to collect sociodemographic, medical information, and patient practice data before, during, 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. Result A total of 421 patients were involved in the study. 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. ADE was reported from 26.1% of the patients and of all the reported ADEs, more than 85% was manifested with gastrointestinal symptoms which include gastrointestinal discomfort(39.1%), nausea (13.6%), constipation(12.7%), diarrhea(12.9%) and anorexia(10%). Determinants of self-reported ADEs among patients in the present study were body mass index above 25 (AOR: 2.55; 95%CI (1.21–5.38), p = 0.014), duration of acid-pepsin disorder more than 3weeks (AOR: 3.57; 95%CI (1.63–7.81), p = 0.001), pain feeling during long interval between meals (AOR: 2.14; 95%CI (1.19–3.84), p = 0.011), and residence in urban area (AOR: 1.95; 95% CI (1.04–3.67), p = 0.038). Conclusion Significant proportion of patients reported ADEs which commonly manifested with gastrointestinal symptoms. Consideration of patients’ body mass index, duration of the disorder, period of the day when patients feel pain, and patients’ area of residence could help to reduce ADEs experienced during H. pylori eradication therapy.
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Affiliation(s)
- Endalew Gebeyehu
- Department of Pharmacology, School of Health Sciences, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Desalegn Nigatu
- Department of Internal Medicine, School of Medicine, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Ephrem Engidawork
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Gebeyehu E, Nigatu D, Engidawork E. 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. PLoS One 2019; 14:e0217645. [PMID: 31163069 PMCID: PMC6548423 DOI: 10.1371/journal.pone.0217645] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 05/15/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Eradication of Helicobacter pylori infection with standard triple therapy has been accepted to curb associated risks of chronic gastritis andpeptic ulcer disease. OBJECTIVE To assess H. pylori eradication rate of standard triple therapy and patient related factors affecting eradication rate. METHODS A 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. RESULTS The 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. CONCLUSION H. 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.
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Affiliation(s)
- Endalew Gebeyehu
- Department of Pharmacology, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Desalegn Nigatu
- Department of Internal Medicine, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Ephrem Engidawork
- Department of Pharmacology, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Puig I, Baylina M, Sánchez-Delgado J, López-Gongora S, Suarez D, García-Iglesias P, Muñoz N, Gisbert JP, Dacoll C, Cohen H, Calvet X. Systematic review and meta-analysis: triple therapy combining a proton-pump inhibitor, amoxicillin and metronidazole forHelicobacter pylorifirst-line treatment. J Antimicrob Chemother 2016; 71:2740-53. [DOI: 10.1093/jac/dkw220] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 05/09/2016] [Indexed: 12/12/2022] Open
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Esmaeili-Dooki MR, Shirdel H, Hajiahmadi M. Eradication of Helicobacter pylori in Children by Triple Therapy Regimens of Amoxicillin, Omeprazole, and Clarithromycin or Azithromycin. IRANIAN JOURNAL OF PEDIATRICS 2015; 25:e2360. [PMID: 26635936 PMCID: PMC4662836 DOI: 10.5812/ijp.2360] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 09/01/2015] [Accepted: 09/28/2015] [Indexed: 01/10/2023]
Abstract
Background and Objectives: The present study aimed to evaluate the effect of classical and azithromycin-containing triple therapy eradication regimen against H. Pylori in children, and to determine the level of patients’ tolerance. Patients and Methods: This single clinical trial was performed in 2014 on 2 to 15 years old children. All children, in whom H. Pylori infection was confirmed through multiple biopsies of the stomach and required treatment, were enrolled in the study. H. Pylori-positive patients were treated alternately with two different drug regimens; Group OCA received clarithromycin 7.5 mg/kg/day every 12 hours for 10 days, amoxicillin 50 mg/kg/day every 12 hours for 10 days, and omeprazole 1 mg/kg/day every 12 hours for two weeks, and Group OAA received azithromycin 10 mg/kg/day once a day (before meal) for 6 days along with amoxicillin and omeprazole. Four to six weeks after completion of treatment, patients’ stool was tested for H. Pylori through the monoclonal method using the Helicobacter antigen quick kit. Results: There were no significant differences between the two groups regarding gender and age of patients. Based on ITT analysis, the therapeutic response in the OAA and OCA groups were 56.2% and 62.5%, respectively (P = 0.40). Drug adverse effects were 15.6% in the OCA and 3.1% in the OAA group (P = 0.19). Conclusions: The therapeutic response was seen in more than half of the patients treated with triple therapy of H. Pylori eradication regimen including azithromycin or clarithromycin, and there was no significant difference between the two treatment groups.
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Affiliation(s)
- Mohammad Reza Esmaeili-Dooki
- Non-Communicable Pediatric Diseases Research Center, Amirkola Children’s Hospital, Babol University of Medical Sciences, Babol, IR Iran
| | - Hossein Shirdel
- Non-Communicable Pediatric Diseases Research Center, Amirkola Children’s Hospital, Babol University of Medical Sciences, Babol, IR Iran
- Corresponding author: Hossein Shirdel, Non-Communicable Pediatric Diseases Research Center, Amirkola Children’s Hospital, Babol University of Medical Sciences, P. O. Box: 4731741151, Babol, IR Iran. Tel: +98-1132346963, Fax: +98-1132346963, E-mail:
| | - Mahmood Hajiahmadi
- Non-Communicable Pediatric Diseases Research Center, Amirkola Children’s Hospital, Babol University of Medical Sciences, Babol, IR Iran
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Ehsani-Ardakani MJ, Sedaghat M, Eslami G, Mohaghegh Shalmani H. The Helicobacter pylori eradication in the group receiving standard -dose and group continue taking amoxicillin for 4 weeks; a clinical trial study. GASTROENTEROLOGY AND HEPATOLOGY FROM BED TO BENCH 2015; 8:S54-9. [PMID: 26171138 PMCID: PMC4495427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIM The aim of this study was to evaluate the Helicobacter pylori eradication in the group receiving standard -dose twice a day for two weeks and continue taking amoxicillin for 4 weeks. BACKGROUND Helicobacter pylori is the major etiological cause of chronic gastritis, gastric and duodenal ulcers, gastric cancer and lymphoma. Therefore, patients should be treated after diagnosis of H. pylori infection. PATIENTS AND METHODS A total of 66 consecutive patients with rapid urease test during endoscopy or biopsy positive for H. pylori were enrolled in this clinical trial study during 2013-2014. Patients were divided randomly into two groups. Group A (standard dose) received omeprazole (20 mg), amoxicillin (1 g), and clarithromycin (500 mg), all two times a day for two weeks. Group B received standard dose like group A and in patients with H.pylori infection amoxicillin were continued for 4 weeks. After completion of treatment, patients did not receive any treatment for a month and then stool antigen was performed to evaluate the H.pylori. RESULTS The rate of successful HP eradication was significantly higher in group A (90.9% V.s 63.6%; p=0.017). Inflation and bitter mouth were found in 8 and 13 patients in group A and 7 and 9 patients in group B, respectively. The incidence of adverse effects was the same (p=0.437). CONCLUSION Increased duration of antibiotic therapy to four weeks significantly raises the rate of successful HP eradication with standard triple therapy without significant increase in adverse effects.
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Affiliation(s)
- Mohammad Javad Ehsani-Ardakani
- Emam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Meghdad Sedaghat
- Emam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Gyti Eslami
- Emam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamid Mohaghegh Shalmani
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Ehsani Ardakani MJ, Aghajanian M, Nasiri AA, Mohaghegh-Shalmani H, Zojaji H, Maleki I. Comparison of half-dose and full-dose triple therapy regimens for Helicobacter pylori eradication in patients with end-stage renal disease. GASTROENTEROLOGY AND HEPATOLOGY FROM BED TO BENCH 2014; 7:151-5. [PMID: 25120895 PMCID: PMC4129565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/08/2014] [Accepted: 05/18/2014] [Indexed: 11/28/2022]
Abstract
AIM The aim of this study was to compare the half-dose and full-dose triple therapy regimens for Helicobacter pylori (Hp) eradication in patients with end-stage renal disease. BACKGROUND H. Pylori is one the most important causes of dyspepsia in patients with end-stage renal disease (ESRD). PATIENTS AND METHODS Sixty-six patients with ESRD were enrolled in the study with Hp infection and peptic disease with a need of Hp eradication. Patients were randomly assigned to full-dose (A=35 patients) or half-dose group (B=31 patients). Patients received clarithromycin 500 mg, amoxicillin 1000 mg and omeprazole 20 mg twice daily in group A and clarithromycin 250 mg and amoxicillin 500 mg twice daily and omeprazole 20 mg once daily in group B for two weeks. Patients provided stool samples 4 weeks of completing study to assess the success of Hp eradication by Hp-specific stool antigen. Finally, the rate of eradication and complications were compared between two groups. RESULTS The successful Hp eradication was achieved in 26 patients (74%) in group A and in 22 patients (74%) in group B. The difference between 2 groups was not statistically significant (p=0.973) (per protocol analysis). CONCLUSION Half-dose triple-therapy with clarithromycin, amoxicillin and omeprazole is as effective as full-dose triple-therapy to eradicate the Hp in patients with ESRD. According to lower toxicity level, complications and cost in half-dose regimen in this subset of patients, this protocol is advised.
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Affiliation(s)
| | - Mohammad Aghajanian
- Imam Hossein Hospital, Shahid Beheshti University of Medical sciences, Tehran, Iran
| | - Amir Ahmad Nasiri
- Imam Hossein Hospital, Shahid Beheshti University of Medical sciences, Tehran, Iran
| | - Hamid Mohaghegh-Shalmani
- Gastroenterology and Liver Diseases Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Homayoun Zojaji
- Gastroenterology and Liver Diseases Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran,Reprint or Correspondence: Homayoun Zojaji, MD.
Gastroenterology and Liver Diseases Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Iradj Maleki
- Mazandaran University of Medical sciences, Sari, Iran
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Masoodi M, Panahian M, Rezadoost A, Heidari A. Eradication Rate of Helicobacter pylori using a Two-week Quadruple Therapy: A Report from Southern Iran. Middle East J Dig Dis 2013; 5:81-5. [PMID: 24829674 PMCID: PMC3990146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Accepted: 02/22/2013] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The use of quadruple therapy for Helicobacter pylori (H. pylori) eradication is a highly efficacious, gold standard regimen. However, according to a number of studies, this regimen has numerous compliance problems and adverse effects. In the current study we have evaluated the H. pylori eradication rate following a quadruple therapy that included omeprazole, bismuth subcitrate, amoxicillin, and metronidazole in Hormozgan, the most southern province in Iran. Hormozgan Province has high rates of H. pylori infection and its related disorders. METHODS A total of 100 patients diagnosed with dyspepsia and H. pylori infection as documented by the (13)C-urea breath test (UBT) or rapid urease test (RUT) were treated with the following quadruple regimen: bismuth subcitrate (120 mg, 2 tablets/q12h), amoxicillin (500 mg/q8h), metronidazole (250 mg/q8h) and omeprazole (20 mg/q12h) for a two-week period. Our primary efficacy outcome was H. pylori eradication as established by a negative UBT at least four weeks after the end of treatment. RESULTS Eradication rates were 79%.and 82.3%, respectively, based on the intention-to-treat and per-protocol analyses. Quadruple therapy had a similar effect in women (81%) and men (83.3%) for the eradication of H. pylori, which was not statistically significant. H. pylori eradication rates according to age groups were: 16-20 years (100%), 21-40 years (81%), and 41-60 years (77.8%; p=0.001). There was no significant difference in H. pylori eradication rate between genders in those less than 20 years of age and the middle age group. However in the older group the eradication rate was significantly higher in women (100%) compared to men (66.6%). CONCLUSION A two-week quadruple therapy that includes omeprazole, bismuth subcitrate, amoxicillin and metronidazole is a highly effective treatment for H. pylori infection. This treatment has an acceptable eradication rate in Southern Iran. The eradication rate appears to be lower in older men compared with younger men or in women.
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Affiliation(s)
- Mohsen Masoodi
- 1Department of Internal Medicine, Gastrointestinal and Liver Disease Research Center (GILDRC), Digestive Disease Research Institute (DDRI), Colorectal Research Center, Rasool Akram Hospital, Tehran University of Medical Sciences, Tehran, Iran
,2Tropical and Infectious Disease Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
,Corresponding Author: Mohsen Masoodi, MD Department of Internal Medicine, Rasool Akram Hospital, Tehran University of Medical Sciences, Tehran, Iran Tele: + 98 21 64352485 Fax: + 98 21 66554064
| | - Mohammad Panahian
- 1Department of Internal Medicine, Gastrointestinal and Liver Disease Research Center (GILDRC), Digestive Disease Research Institute (DDRI), Colorectal Research Center, Rasool Akram Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Amirmansoor Rezadoost
- 1Department of Internal Medicine, Gastrointestinal and Liver Disease Research Center (GILDRC), Digestive Disease Research Institute (DDRI), Colorectal Research Center, Rasool Akram Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Amin Heidari
- 2Tropical and Infectious Disease Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
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Rifat uz Zaman, Akhtar MS, Khan MS. Anti-ulcer activity of NS-EA 51 – A fraction of Nigella sativa seed, in histamine plus pylorus-ligated and hypothermia plus restrain stressed rat models. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/j.jopr.2012.11.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Sánchez-Delgado J, García-Iglesias P, Castro-Fernández M, Bory F, Barenys M, Bujanda L, Lisozain J, Calvo MM, Torra S, Gisbert JP, Calvet X. High-dose, ten-day esomeprazole, amoxicillin and metronidazole triple therapy achieves high Helicobacter pylori eradication rates. Aliment Pharmacol Ther 2012; 36:190-6. [PMID: 22591220 DOI: 10.1111/j.1365-2036.2012.05137.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Revised: 03/15/2012] [Accepted: 04/25/2012] [Indexed: 12/12/2022]
Abstract
BACKGROUND Strong acid inhibition using esomeprazole increases cure rates with triple therapy and 10-day treatments are more effective than 7-day ones. The combination of amoxicillin plus metronidazole at full doses, and using a physiologically-correct schedule three times a day, and has been shown to overcome metronidazole resistance and to achieve good eradication rates. AIMS To assess the eradication rate of a new first-line treatment regimen associating strong acid inhibition, amoxicillin and metronidazole and to evaluate tolerance. METHODS Patients from eight hospitals were included. Helicobacter pylori status was assessed by at least one of the following: histology, culture, rapid urease test or urea breath test (UBT). Ten-day treatment was prescribed comprising esomeprazole 40 mg twice a day plus amoxicillin 1 g and metronidazol 500 mg both three times a day. Helicobacter pylori cure was assessed by UBT. RESULTS A hundred and thirty-six patients were enrolled. Mean age was 52.6 ± 16 years and 59.6% of patients were men. Main indications for treatment were: uninvestigated dyspepsia (13.6%); functional dyspepsia (18.2%); gastric ulcer (21.8%); and duodenal ulcer (39.8%). Helicobacter pylori eradication was achieved in 112 of the 127 patients who returned for follow-up. Eradication rates were 82.4% (95% CI: 74.7-88.1) by intention-to-treat analysis and 88.2% (95% CI: 81.2-92.8) by per protocol. Treatment was well tolerated and no major side effects were reported. Nine patients complained of mild side effects. CONCLUSIONS Cure rates of the combination of esomeprazole, amoxicillin and metronidazole are high and the treatment was well tolerated. This pilot study warrants the comparison of this schedule with current standards.
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Affiliation(s)
- J Sánchez-Delgado
- Gastroenterology Unit, Hospital Parc Taulí, Departament de Medicina, Universitat Autònoma de Barcelona, Sabadell, Spain
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Zaater MF, Tahboub YR, Ghanem E. Determination and Stability Assessment of Clarithromycin in Human Plasma using RP-LC with Electrochemical Detection. J Chromatogr Sci 2012; 50:763-8. [DOI: 10.1093/chromsci/bms055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Zhou C, Ma HS. Effects of lactobacillus on phosphorylated p38 mitogen-activated protein kinase and apoptosis in SGC-7901 cells treated with lipopolysaccharide of Helicobacter pylori. Shijie Huaren Xiaohua Zazhi 2007; 15:807-812. [DOI: 10.11569/wcjd.v15.i8.807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate effects of lactobacillus bulgaricus (LBG) on the levels of phosphorylated p38 mitogen-activated protein kinase (P-p38MAPK) and apoptosis index (AI) in gastric cancer cell line SGC-7901 treated with lipopolysaccharide of H. pylori Sydney strain 1 (H. pylori SS1-LPS).
METHODS: Human gastric cancer cell line SGC-7901 was treated with H. pylori SS1-LPS at the concentration of 2.5×103, 2.5×104, 2.5 ×105 EU/L, respectively, after pretreatment for 1 h with 10 mmol/L SB203580 (blocker of p38MAPK) or 1×1013 CFU/L LBG. The level of P-p38MAPK was analyzed by immunocytochemistry after 2 h of H. pylori SS1-LPS treatment. The cell activity was detected by MTT assay after 4、5 and 6 h of treatment, and the apoptosis was measured by flow cytometry at the 6th hour.
RESULTS: H. pylori SS1-LPS inhibited cell activity (0.164 ± 0.028 vs 0.622 ± 0.068, P < 0.05) and up-regulated the level of P-p38MAPK (79.771 ± 1.424 vs 4.075 ± 0.135, P < 0.01) and AI value (10.000% ± 0.510% vs 4.175% ± 0.206%, P < 0.05) in a dose-dependent manner. The level of P-p38MAPK and AI value in SGC-7901 cells were not significantly different between LBG pretreatment group and the controls, and the cell activity and AI value were not markedly different between SB203580 pretreatment group and the controls.
CONCLUSION: H. pylori SS1-LPS may induce the apoptosis of SGC-7901 cells by activating the phosphorylation of p38MAPK, while LBG can prevent H. pylori SS1-LPS-induced apoptosis of SGC-7901 cells by inhibiting the phosphorylation of p38MAPK.
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Robert R, Gissot V, Pierrot M, Laksiri L, Mercier E, Prat G, Villers D, Vincent JF, Hira M, Vignon P, Charlot P, Burucoa C. Helicobacter pylori infection is not associated with an increased hemorrhagic risk in patients in the intensive care unit. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2006; 10:R77. [PMID: 16704741 PMCID: PMC1550927 DOI: 10.1186/cc4920] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/19/2005] [Revised: 04/11/2006] [Accepted: 04/18/2006] [Indexed: 02/08/2023]
Abstract
Introduction The potential role of Helicobacter pylori in acute stress ulcer in patients in an intensive care unit (ICU) is controversial. The aim of this study was to determine the frequency of H. pylori infection in ICU patients by antigen detection on rectal swabs, and to analyze the potential relationship between the presence of H. pylori and the risk of digestive gastrointestinal bleeding. Methods In this prospective, multicenter, epidemiological study, the inclusion criteria were as follows: patients admitted to the 12 participating ICU for at least two days, who were free of hemorrhagic shock and did not receive more than four units of red blood cells during the day before or the first 48 hours after admission to the ICU. Rectal swabs were obtained within the first 24 hours of admission to the ICU and were tested for H. pylori antigens with the ImmunoCard STAT! HpSA kit. The following events were analyzed according to H. pylori status: gastrointestinal bleeding, unexplained decline in hematocrit, and the number of red cell transfusions. Results The study involved 1,776 patients. Forty-nine patients (2.8%) had clinical evidence of upper digestive bleeding. Esophagogastroduodenoscopy was performed in 7.6% of patients. Five hundred patients (28.2%) required blood transfusion. H. pylori antigen was detected in 6.3% of patients (95% confidence interval 5.2 to 7.5). H. pylori antigen positivity was associated with female sex (p < 0.05) and with a higher Simplified Acute Physiology Score II (SAPS II; p < 0.05). H. pylori antigen status was not associated with the use of fiber-optic gastroscopy, the need for red cell transfusions, or the number of red cell units infused. Conclusion This large study reported a small percentage of H. pylori infection detected with rectal swab sampling in ICU patients and showed that the patients infected with H. pylori had no additional risk of gastrointestinal bleeding. Thus H. pylori does not seem to have a major role in the pathogenesis of acute stress ulcer in ICU patients.
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Affiliation(s)
- René Robert
- Réanimation Médicale, CHU Poitiers, 2 rue de la milèterie, BP 577 86021 Poitiers cedex France
| | - Valérie Gissot
- Réanimation Polyvalente, Hopital Girac 16140 Saint Michel France
| | - Marc Pierrot
- Réanimation Médicale, CHU Angers 4 rue Larrey 49100 Angers France
| | - Leila Laksiri
- Réanimation Chirurgicale, CHU Poitiers, 2 rue de la milèterie, BP 577, 86021 Poitiers cedex France
| | - Emmanuelle Mercier
- Réanimation Médicale, CHU Bretonneau, 2 Boulevard Tonnelé 37044 Tours, France
| | - Gwenael Prat
- Réanimation Médicale, CHU de la Cavale Blanche rue Tanguy Pringent 29200 Brest, France
| | - Daniel Villers
- Réanimation Médicale, CHU Nantes, 1 place Alexis Ricordeau 44093 Nantes cedex, France
| | - Jean-François Vincent
- Réanimation Polyvalente, Centre hospitalier de Saintes, 9 place du 11 novembre BP 326, 17108 Saintes cedex, France
| | - Michel Hira
- Réanimation Polyvalente Chateauroux, Centre hospitalier de Chateauroux 216 avenue de verdun 36000 Chateauroux, France
| | - Philippe Vignon
- Réanimation Polyvalente Limoges, CHU Dupuytren 2 avenue Martin Luther King 87042 Limoges cedex, France
| | - Patrick Charlot
- Réanimation Polyvalente Niort, 40 avenue du général de Gaulle 79000 Niort, France
| | - Christophe Burucoa
- Laboratoire de Microbiologie A EA 3807, CHU Poitiers, 2 rue de la milèterie, BP 577, 86021 Poitiers cedex France
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