The Medical Letter on Drugs and Therapeutics
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ISSUE 1525
ISSUE 1525
July 17, 2017
Drugs for Helicobacter pylori Infection
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July 17, 2017 (Issue: 1525)
Revised 3/7/18: Information warning about an increased risk of cardiac events and death with clarithromycin has been added.
About 50% of the world’s population is infected with Helicobacter pylori. These gastric bacteria can cause chronic inflammation and have been associated with development of gastritis, peptic ulcer disease, gastric adenocarcinoma, and gastric mucosa-associated lymphoid tissue (MALT) lymphoma.1 Eradication of H. pylori can promote gastric healing, prevent recurrence of duodenal and gastric ulcers, and reduce the incidence of gastric cancer.2,3 Guidelines for treatment of H. pylori infection were updated recently.4-6
NONINVASIVE TESTING — Urea Breath Tests – A urea breath test (BreathTek; BreathID; PYtest) can be used for office-based diagnosis of H. pylori infection. The patient ingests a urea solution or urea-containing capsule labeled with a carbon
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- CA Fallone et al. The Toronto consensus for the treatment of Helicobacter pylori infection in adults. Gastroenterology 2016; 151:51.
- WD Chey et al. ACG Clinical Guideline: treatment of Helicobacter pylori infection. Am J Gastroenterol 2017; 112:212.
- P Malfertheiner et al. Management of Helicobacter pylori infection – the Maastricht V/Florence Consensus Report. Gut 2017; 66:6.
- MP Dore et al. Dyspepsia: when and how to test for Helicobacter pylori infection. Gastroenterol Res Pract 2016 April 28 (epub).
- S Shiota et al. Antibiotic resistance of Helicobacter pylori among male United States veterans. Clin Gastroenterol Hepatol 2015; 13:1616.
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- M Venerito et al. Meta-analysis of bismuth quadruple therapy versus clarithromycin triple therapy for empiric primary treatment of Helicobacter pylori infection. Digestion 2013; 88:33.
- JP Gisbert and X Calvet. Update on non-bismuth quadruple (concomitant) therapy for eradication of Helicobacter pylori. Clin Exp Gastroenterol 2012; 5:23.
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- PP Basu et al. A randomized study comparing levofloxacin, omeprazole, nitazoxanide, and doxycycline versus triple therapy for the eradication of Helicobacter pylori. Am J Gastroenterol 2011; 106:1970.
- E Coss et al. Sequential therapy is not better at eradication of primary Helicobacter pylori infection when compared to standard triple therapy in the United States–a prospective, randomized evaluation in a United States population. Gastroenterology 2014; 146:S399. Abstract Su1194.
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- AG McNicholl et al. Randomised clinical trial comparing sequential and concomitant therapies for Helicobacter pylori eradication in routine clinical practice. Gut 2014; 63:244.
- SD Georgopoulos et al. Randomized clinical trial comparing ten day concomitant and sequential therapies for Helicobacter pylori eradication in a high clarithromycin resistance area. Eur J Intern Med 2016; 32:84.
- PB Kale-Pradhan et al. Fluoroquinolone sequential therapy for Helicobacter pylori: a meta-analysis. Pharmacotherapy 2015; 35:719.
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- Probiotics revisited. Med Lett Drugs Ther 2013; 55:3.
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- AC Marin et al. Efficacy of a second-line levofloxacin-containing triple therapy after the failure of the non-bismuth sequential or concomitant treatments: systematic review and meta-analysis. Helicobacter 2014; 19 (Suppl 1):139, abstract P11.39.
- AC Marin et al. A review of rescue regimens after clarithromycincontaining triple therapy failure (for Helicobacter pylori eradication). Expert Opin Pharmacother 2013; 14:843.
- T Shaikh and CA Fallone. Effectiveness of second through sixth line salvage Helicobacter pylori treatment: bismuth quadruple therapy is almost always a reasonable choice. Can J Gastroenterol Hepatol 2016 March 29 (epub).
- JP Gisbert et al. Fourth-line rescue therapy with rifabutin in patients with three Helicobacter pylori eradication failures. Aliment Pharmacol Ther 2012; 35:941.
- J Molina-Infante and A Shiotani. Practical aspects in choosing Helicobacter pylori therapy. Gastroenterol Clin North Am 2015; 44:519.
- C Giuliano et al. Are proton pump inhibitors associated with the development of community-acquired pneumonia? A meta-analysis. Expert Rev Clin Pharmacol 2012; 5:337.
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- CS Kwok et al. Risk of Clostridium difficile infection with acid suppressing drugs and antibiotics: a meta-analysis. Am J Gastroenterol 2012; 107:1011.
- Inhibitors and inducers of CYP enzymes and p-glycoprotein. Med Lett Drugs Ther 2017. May 18 (epub). Available at: medicalletter.org/downloads/CYP_PGP_Tables.pdf. Accessed June 29, 2017.
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- Drug interaction: clopidogrel and PPIs. Med Lett Drugs Ther 2017; 59:39.
- FDA Drug Safety Communication: FDA review finds additional data supports the potential for increased long-term risks with antibiotic clarithromycin (Biaxin) in patients with heart disease. Available at: www.fda.gov/drugs/drugsafety/ucm597289.htm. Accessed March 7, 2018.
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Title: Drugs for Helicobacter pylori Infection
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