Standard triple therapies are the most used treatment in the clinical practice. However, a critical fall in the H. pylori eradication rate following these therapies has been observed in the last few years 61,62. This finding most likely depends on an increased clarithromycin resistance. Indeed, a large study performed in 14 European countries showed a primary clarithromycin rate as high as 20% even in children 104. Similarly, recent Italian studies found a prevalence rate raging from 16.9% to 31.5% in adults88,89. To improve the efficacy of triple therapy in those areas with >1520% primary clarithromycin resistance, the use of 14-day regimen or a 1014 days quadruple therapy has been recently proposed in the updated European guidelines 59. However, as above mentioned, quadruple therapy is no more feasible in Italy, and the prolonged 14-day triple therapy has an unfavourable cost-efficacy ratio 63. On the other hand, only few novel molecules owing a bactericidal action against this bacterium and with a potential development in the next future have been identified in the last 5 years 105. The sequential regimen is a novel therapeutic approach based on a different combination of the available antibiotics, and more than 1800 patients have been treated with such a therapy. It is the only therapeutic regimen, which has been proven to be superior to 710 days triple therapies in large, multicenter, randomised trials. Moreover, the sequential regimen has achieved an eradication rate constantly higher than 90% at ITT analysis in all but one small study performed in children. Primary clarithromycin resistance seems to be the only factor reducing the efficacy of this therapy regimen. However, even in these patients, an acceptable >75% eradication rate can be achieved following the sequential therapy, a success rate significantly higher than that observed with the standard 710 days triple therapies (<35%) 77,88-89. The attention towards the sequential therapy regimen is increasing in literature. Several authoritative experts have defined such a therapeutic approach as ‘appealing’ 105112, and the International panel of the European guidelines advised that ‘sequential therapy deserves further evaluation in different regions’ 59. Finally, the sequential regimen, equally to standard 714 triple therapies, is now advised as a first-line treatment in the updated Italian guidelines on H. pylori management 113. We therefore encourage gastroenterologists to validate the sequential therapy in other geographical areas where data are still lacking. If patients are – as they always should be – our first priority, time for a change is eventually mature!

An Atlas of Investigation and Management: HELICOBACTER PYLORI

VAIRA, BERARDINO
2012

Abstract

Standard triple therapies are the most used treatment in the clinical practice. However, a critical fall in the H. pylori eradication rate following these therapies has been observed in the last few years 61,62. This finding most likely depends on an increased clarithromycin resistance. Indeed, a large study performed in 14 European countries showed a primary clarithromycin rate as high as 20% even in children 104. Similarly, recent Italian studies found a prevalence rate raging from 16.9% to 31.5% in adults88,89. To improve the efficacy of triple therapy in those areas with >1520% primary clarithromycin resistance, the use of 14-day regimen or a 1014 days quadruple therapy has been recently proposed in the updated European guidelines 59. However, as above mentioned, quadruple therapy is no more feasible in Italy, and the prolonged 14-day triple therapy has an unfavourable cost-efficacy ratio 63. On the other hand, only few novel molecules owing a bactericidal action against this bacterium and with a potential development in the next future have been identified in the last 5 years 105. The sequential regimen is a novel therapeutic approach based on a different combination of the available antibiotics, and more than 1800 patients have been treated with such a therapy. It is the only therapeutic regimen, which has been proven to be superior to 710 days triple therapies in large, multicenter, randomised trials. Moreover, the sequential regimen has achieved an eradication rate constantly higher than 90% at ITT analysis in all but one small study performed in children. Primary clarithromycin resistance seems to be the only factor reducing the efficacy of this therapy regimen. However, even in these patients, an acceptable >75% eradication rate can be achieved following the sequential therapy, a success rate significantly higher than that observed with the standard 710 days triple therapies (<35%) 77,88-89. The attention towards the sequential therapy regimen is increasing in literature. Several authoritative experts have defined such a therapeutic approach as ‘appealing’ 105112, and the International panel of the European guidelines advised that ‘sequential therapy deserves further evaluation in different regions’ 59. Finally, the sequential regimen, equally to standard 714 triple therapies, is now advised as a first-line treatment in the updated Italian guidelines on H. pylori management 113. We therefore encourage gastroenterologists to validate the sequential therapy in other geographical areas where data are still lacking. If patients are – as they always should be – our first priority, time for a change is eventually mature!
2012
152
9781904392897
Holton J; Figura N; Vaira D
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11585/114053
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