• Antibiotic resistance
• GRDDS
• Helicobacter pylori
• Nanomedicine
• Peptic ulcer disease

• continuing health education
• helicobacter pylori eradication
• helicobacter pylori
• race-based differences
• socio-economic factors

• S-adenosylmethionine
• antibiotic resistance
• flagella synthesis
• futalosine menaquinone pathway
• gastric ulcers
• iron transport

• H pylori
• refractory
• surveillance
• treatment
• treatment failure

Nowadays, apart from having to know first-line Helicobacter pylori eradication regimens well, we must also be prepared to face treatment failures. The aim of this review is to summarize the role of rifabutin in the management of H. pylori infection. Bibliographical searches were performed in PubMed. Data on resistance and efficacy of rifabutin-containing regimens on H. pylori eradication were meta-analyzed. Mean H. pylori rifabutin resistance rate (39 studies, including 9721 patients) was 0.13%; when studies only including patients naïve to H. pylori eradication treatment were considered, this figure was even lower (0.07%). Mean H. pylori eradication rate (by intention-to-treat) with rifabutin-containing regimens (3052 patients) was 73%. Respective cure rates for second-, third-, fourth- and fifth-line therapies, were 79%, 69%, 69% and 72%. Most studies administered rifabutin 300 mg/day, which seemed to be more effective than 150 mg/day. The ideal length of treatment remains unclear, but 10–12-day regimens are generally recommended. Adverse events to rifabutin treatment in H. pylori studies were relatively infrequent (15%), and severe adverse events were exceptional (myelotoxicity was the most significant, although always reversible). In summary, rifabutin-containing therapy represents an encouraging strategy generally restricted, at present, to patients where previous (usually multiple) eradication regimens have failed.

• H. pylori
• Helicobacter pylori
• rescue
• rifabutin
• treatment

• Bismuth quadruple regimen
• Dyspeptic patients
• H. pylori
• Rescue therapy
• Rifabutin

• Amoxicillin/therapeutic use
• Anti-Bacterial Agents/therapeutic use
• Bismuth/therapeutic use
• Drug Therapy, Combination
• Helicobacter Infections/drug therapy
• Helicobacter pylori
• Humans
• Metronidazole
• Proton Pump Inhibitors/therapeutic use
• Rifabutin/therapeutic use
• Treatment Outcome

• cyp2c19
• duration
• helicobacter pylori
• ilaprazole
• treatment

• 2-Pyridinylmethylsulfinylbenzimidazoles/administration & dosage
• Amoxicillin/administration & dosage
• Anti-Bacterial Agents/administration & dosage
• Clarithromycin/administration & dosage
• Drug Therapy, Combination
• Female
• Helicobacter Infections/drug therapy
• Helicobacter pylori/drug effects
• Humans
• Male
• Middle Aged
• Prospective Studies

The prevalence of Helicobacter pylori resistance to metronidazole and clarithromycin is high in Indonesia. Moreover, the increasing levofloxacin resistance rates in the absence of bismuth treatment in Indonesia has led to the use of other antibiotics as alternative regimens.

We determined the minimum inhibitory concentrations (MICs) of five alternative antibiotics for H. pylori (rifaximin, rifabutin, furazolidone, garenoxacin, and sitafloxacin) using the agar dilution method and assessed mutations associated with antibiotic resistance using next-generation sequencing.

Analysis of 106 strains isolated from 1039 adult dyspeptic patients revealed that none of the strains were furazolidone-resistant. All strains were also sensitive to rifabutin and sitafloxacin. In contrast, the rates of resistance to rifaximin and garenoxacin were high (38.9% and 6.7%, respectively). The strains isolated from patients on Java Island had the highest resistance rates to garenoxacin and rifaximin. In addition, the resistance was distributed evenly among the ethnic groups, ranging between 25.0% and 69.2%. Except for rifaximin, for which the resistance rate was 38.9%, the other four antibiotics could be successfully employed to eradicate levofloxacin- and metronidazole-resistant H. pylori infections in vitro. Interestingly, garenoxacin-sensitive strains were found in regions with high clarithromycin resistance rates such as Bali and Papua Islands. In contrast, rifaximin might not be considered as an alternative antibiotic in regions with high clarithromycin resistance. There was an inconsistent association between gyrA and gyrB mutations and garenoxacin resistance. We confirmed that the I837V (replacement of isoleucine at position 837 with valine), A2414T/V, Q2079K and K2068R were the predominant rpoB point mutations. There was an association between vacA genotypes of H. pylori and rifaximin resistance (P = 0.048).

furazolidone-, rifabutin-, and sitafloxacin-based therapies might be considered as alternative regimens to eradicate H. pylori in Indonesia, including regions with high metronidazole and clarithromycin resistance rates. Moreover, sitafloxacin but not garenoxacin should be considered for eradication of levofloxacin-resistant strains.

• Helicobacter pylori
• Indonesia
• antibiotics
• drug resistance

• Eradication
• Fourth-generation quinolones
• Helicobacter pylori
• Meta-analysis
• Systematic review

• Anti-Bacterial Agents/pharmacology
• Anti-Bacterial Agents/therapeutic use
• Drug Therapy, Combination/methods
• Helicobacter Infections/drug therapy
• Helicobacter Infections/microbiology
• Helicobacter pylori/drug effects
• Helicobacter pylori/isolation & purification
• Humans
• Intention to Treat Analysis
• Microbial Sensitivity Tests
• Proton Pump Inhibitors/therapeutic use
• Quinolones/pharmacology
• Quinolones/therapeutic use
• Treatment Outcome

Small intestinal bacterial overgrowth (SIBO) may coexist with Helicobacter pylori infection, which can be the cause of chronic gastrointestinal complaints.

Evaluation of the therapeutic efficacy of amoxicillin and rifaximin in the treatment of these diseases.

The lactulose hydrogen breath test (LHBT) and the urea breath test (¹³C-UBT) were performed in 116 patients. In 62 patients the coexistence of small intestinal bacterial overgrowth and H. pylori infection was observed. Then, in group I (n = 30) pantoprazole (2 × 40 mg), amoxicillin (2 × 1000 mg) and metronidazole (2 × 500 mg) and in group II (n = 32) pantoprazole and amoxicillin at the above doses and rifaximin (3 × 400 mg) were administered for 10 days. After 6 weeks, both breath tests were repeated and the degree of remission of symptoms was measured using a 10-point visual analog scale (VAS).

After the treatment the LHBT index decreased in group I from 61.2 ±19.4 ppm to 22.0 ±8.2 ppm (p < 0.001) and in group II from 59.6 ±15.5 ppm to 15.2 ±8.6 ppm (p < 0.001). Eradication of H. pylori (¹³C-UBT below 4.0‰) was achieved in 63.3% of patients in group I and 59.4% in group II (p > 0.05). The decrease of pain below 3.0 points in the VAS was obtained in 64.8% of patients in group I and in 56.2% in group II.

Combination of amoxicillin and rifaximin may be effective in the treatment of patients with small intestinal bacterial overgrowth syndrome and concomitant H. pylori infection.

• Helicobacter pylori
• amoxicillin
• rifaximin
• small intestinal bacterial overgrowth
• therapy

• Pylera
• bismuth
• helicobacter
• quadruple therapy
• rescue
• third-line

• Clarithromycin
• Efficacy
• First-line therapy
• Fluoroquinolone
• Helicobacter pylori
• Infection

• Helicobacter pylori
• adolescents
• antimicrobial resistance
• children
• southwest Germany

• Bismuth
• Cytotoxicity
• Gender
• Neoplasm
• Stem cells

• Aged
• Bismuth/administration & dosage
• Bismuth/pharmacology
• Bismuth/therapeutic use
• Double-Blind Method
• Female
• Hematopoietic Stem Cell Transplantation/methods
• Humans
• Lymphoma/drug therapy
• Lymphoma/pathology
• Male
• Middle Aged
• Multiple Myeloma/drug therapy
• Multiple Myeloma/pathology
• Pilot Projects
• Prospective Studies
• Transplantation Conditioning/methods
• Transplantation, Autologous/methods
• Treatment Outcome

• Esomeprazole
• Helicobacter pylori
• Sitafloxacin
• Third-line eradication

• Antimicrobial resistance
• amoxicillin
• clarithromycin
• levofloxacin
• metronidazole
• tetracycline

AIM: To determine changes in the antibiotic resistance of Helicobacter pylori (H. pylori) in southern Taiwan after failure of first-line standard triple therapy.

METHODS: We analyzed 137 H. pylori-infected isolates from patients who experienced eradication failure after standard first-line triple therapy from January 2010 to December 2014. The H. pylori strains were tested for susceptibility to amoxicillin, clarithromycin, levofloxacin, metronidazole and tetracycline using the E-test method. The minimal inhibitory concentration (MIC) was determined by the agar dilution test. MIC values of ≥ 0.5, ≥ 1, ≥ 1, ≥ 4 and ≥ 8 mg/L were considered to be the resistance breakpoints for amoxicillin, clarithromycin, levofloxacin, tetracycline and metronidazole, respectively.

RESULTS: A high resistance rate was found for clarithromycin (65%-75%) and metronidazole (30%-40%) among patients who failed first-line standard therapy. The resistance levels to amoxicillin and tetracycline remained very low; however, levofloxacin resistance was as high as 37.5% in 2010 but did not increase any further during the past 5 years. The rates of resistance to these antibiotics did not show a statistically significant upward or downward trend.

CONCLUSION: Antibiotic resistance of H. pylori remains a problem for the effective eradication of this pathogen and its associated diseases in Taiwan. High clarithromycin resistance indicated that this antibiotic should not be prescribed as a second-line H. pylori eradication therapy. Moreover, levofloxacin-based second-line therapy should be used cautiously, and the local resistance rates should be carefully monitored.

• Helicobacter pylori
• Antibiotic resistance
• Five-year sequential changes
• Failed first-line therapy
• Southern Taiwan

• Amoxicillin/therapeutic use
• Anti-Bacterial Agents/therapeutic use
• Biopsy
• Clarithromycin/therapeutic use
• Drug Resistance, Bacterial
• Drug Resistance, Microbial
• Helicobacter Infections/drug therapy
• Helicobacter Infections/microbiology
• Helicobacter pylori/drug effects
• Humans
• Levofloxacin/therapeutic use
• Metronidazole/therapeutic use
• Microbial Sensitivity Tests
• Retrospective Studies
• Taiwan
• Tetracycline/therapeutic use
• Time Factors

• Gastric diseases
• H. pylori eradication
• H. pylori resistance
• Helicobacter pylori
• Treatment

• Clarithromycin resistance
• Helicobacter pylori
• Standard triple therapy

The bismuth-based quadruple regimen has been applied in Helicobacter pylori rescue therapy worldwide. The non-bismuth-based quadruple therapy or “concomitant therapy” is an alternative option in first-line eradication but has not been used in second-line therapy. Discovering a valid regimen for rescue therapy in bismuth-unavailable countries is important. We conducted a randomized controlled trial to compare the efficacies of the standard quadruple therapy and a modified concomitant regimen. One hundred and twenty-four patients were randomly assigned into two groups: RBTM (rabeprozole 20 mg bid., bismuth subcitrate 120 mg qid, tetracycline 500 mg qid, and metronidazole 250 mg qid) and RATM (rabeprozole 20 mg bid., amoxicillin 1 g bid., tetracycline 500 mg qid, and metronidazole 250 mg qid) for 10 days. The eradication rate of the RBTM and RATM regimen was 92.1% and 90.2%, respectively, in intention-to-treat analysis. Patients in both groups had good compliance (~96%). The overall incidence of adverse events was higher in the RATM group (42.6% versus 22.2%, P = 0.02), but only seven patients (11.5%) experienced grades 2-3 events. In conclusion, both regimens had good efficacy, compliance, and acceptable side effects. The 10-day RATM treatment could be an alternative rescue therapy in bismuth-unavailable countries.

• Clarithromycin
• Furazolidone
• Helicobacter pylori
• Second-line therapy

• Rifabutin
• amoxicillin
• high-dose proton-pump inhibitor
• third-line recue therapy

• Adult
• Aged
• Amoxicillin/administration & dosage
• Amoxicillin/adverse effects
• Anti-Bacterial Agents/administration & dosage
• Anti-Bacterial Agents/adverse effects
• Drug Administration Schedule
• Drug Resistance, Bacterial
• Drug Therapy, Combination/adverse effects
• Female
• Helicobacter Infections/drug therapy
• Helicobacter Infections/microbiology
• Helicobacter pylori/drug effects
• Helicobacter pylori/physiology
• Humans
• Male
• Prospective Studies
• Proton Pump Inhibitors/administration & dosage
• Proton Pump Inhibitors/adverse effects
• Republic of Korea
• Rifabutin/administration & dosage
• Rifabutin/adverse effects
• Treatment Outcome

Helicobacter pylori infection is a common chronic human bacterial infection. Triple- therapy regimen containing a proton pump inhibitor, clarithromycin, and either amoxicillin or metronidazole is commonly used as first-line treatment for its eradication. However, it may not provide the acceptable eradication rate. The present study was designed to evaluated efficacy of low dose furazolidone with amoxicillin and omeprazole for eradication of H. pylori.

One hundred twenty patients with non- ulcer dyspepsia or peptic ulcer confirmed by upper GI endoscopy, plus H. pylori infection confirmed by rapid urease test were included in the study. They were randomly divided into two groups, and then received clarithromycin, amoxicillin, and omeprazole, or furazolidone (100 mg PO bid), amoxicillin, and omeprazole. They were evaluated using urea breath test at the end of the study.

The eradication rates were 57.6% and 78.8% in clarithromycin and furazolidone groups, respectively. Their difference was statistically significant (P value 0.013). No side effect was seen in the furazolidone group.

Low dose furazolidone rather than clarithromycin can be used as low- cost and effective drug for eradication of H. pylori, in combination with amoxicillin and omeprazole.