minocycline and Helicobacter-Infections

The effective regimen is lacking in areas with high antibiotic resistance and tetracycline unavailable. Whether minocycline can replace tetracycline for Helicobacter pylori eradication is unknown. This meta-analysis compared and summarized the efficacy and safety profiles of H. pylori quadruple regimens with and without minocycline.. We conducted a literature search for regimens including minocycline quadruple therapy for H. pylori eradication and adverse events (AEs). Controls were patients undergoing any other treatment without minocycline. Searches were performed up to July 20, 2023, using PubMed and the Cochrane library.. We demonstrated the H. pylori eradication effect of minocycline quadruple therapy, and it might be an optional therapy. The safety of regimens containing minocycline was relatively satisfactory.

Topics: Amoxicillin; Anti-Bacterial Agents; Bismuth; Drug Therapy, Combination; Helicobacter Infections; Helicobacter pylori; Humans; Minocycline; Randomized Controlled Trials as Topic; Tetracycline; Treatment Outcome

The decreasing Helicobacter pylori eradication rate and the increasing antibiotic resistance trend are of great concern. Therefore, new and effective therapies are needed for H. pylori infection. We conducted a systematic review and meta-analysis to assess the efficacy and safety of semisynthetic tetracycline regimens in H. pylori treatment.. PubMed, EMBASE, and the Cochrane library were searched. The outcome indicators were the eradication rate, risk ratio (RR, ie, the risk of the semisynthetic tetracycline regimen relative to the control), and 95% confidence interval (95% CI). Controls were patients undergoing any other treatment without semisynthetic tetracycline.. Twenty-three studies with 5240 participants were included. The eradication rates of triple regimens with semisynthetic tetracyclines in most studies were less than 70% in both the intention-to-treat (ITT) and the per-protocol (PP) analyses. The pooled eradication rates of quadruple therapies with doxycycline and controls were 95% and 84% in the PP analyses, respectively. The pooled RR associated with efficacy in the quadruple therapy with doxycycline group compared with the control group was 1.12 (95% CI: 1.04-1.20) in the PP analysis. The pooled RR of side effects in the quadruple therapy with doxycycline group compared with the control group was 1.01 (95% CI: 0.65-1.55).. Seven-day and ten-day quadruple therapy with doxycycline might be an optional first-line therapy. The safety of regimens containing semisynthetic tetracyclines was relatively satisfactory. However, the triple regimen is not recommended.

Topics: Amoxicillin; Anti-Bacterial Agents; Doxycycline; Drug Therapy, Combination; Helicobacter Infections; Helicobacter pylori; Humans; Minocycline; Treatment Outcome

Topics: Anti-Bacterial Agents; Bacterial Proteins; Drug Resistance, Bacterial; Drug Therapy, Combination; Helicobacter Infections; Helicobacter pylori; Humans; Minocycline; Ribosomal Proteins

We investigated the prevalence of Helicobacter pylori infection and the effect of its eradication in a series of 61 chronic ITP patients. H. pylori infection was found in 53 (86.9%) of 61 ITP patients. H. pylori eradication were performed in 44 infected ITP patients and succeeded in 28 (63.6%) patients. 20 (71.4%) of those 28 patients had platelet recovery and 15 (53.6%) patients achieved a remission, and that effect continue (about 2 years). And we investigated relation with ITP and upper gastrointestinal disease. 2 (3.8%) of 53 H. pylori infected cases were gastric ulcer, 1 (1.9%) was duodenal ulcer and 1 (1.9%) was gastric cancer. All cases were chronic atrophic gastritis, and localized atrophic cases achieved a remission after eradication of H. pylori.

Topics: Aged; Anti-Infective Agents; Clarithromycin; Drug Therapy, Combination; Female; Helicobacter Infections; Helicobacter pylori; Humans; Male; Metronidazole; Middle Aged; Minocycline; Platelet Count; Purpura, Thrombocytopenic, Idiopathic

Topics: 2-Pyridinylmethylsulfinylbenzimidazoles; Benzimidazoles; Clarithromycin; Drug Administration Schedule; Drug Resistance, Bacterial; Drug Therapy, Combination; Helicobacter Infections; Helicobacter pylori; Humans; Metronidazole; Minocycline; Omeprazole; Rabeprazole; Treatment Failure

Helicobacter pylori eradication in penicillin-allergic patients is challenging. The effective regimen is lacking in areas with high antibiotic resistance and tetracycline unavailable. Minocycline, cefuroxime, and full-dose metronidazole are promising drugs.. To compare the eradication rate, safety, and compliance among three new bismuth quadruple therapies for first-line H. pylori eradication in penicillin-allergic patients.. This randomized trial was conducted on 450 naive patients with H. pylori infection and penicillin allergy. The 14-day minocycline-metronidazole-containing (minocycline 100 mg twice daily and metronidazole 400 mg four times/day), minocycline-cefuroxime-containing (minocycline 100 mg twice daily and cefuroxime 500 mg twice daily), and cefuroxime-metronidazole-containing (cefuroxime 500 mg twice daily and metronidazole 400 mg four times/day) bismuth quadruple therapies were randomly assigned to the participants. Safety and compliance were assessed within 3 days after eradication. Urea breath test was performed 4-8 weeks after eradication to evaluate outcome.. The differences of eradication rates in either intention-to-treat (84.0%, 82.7%, and 23 82.0%, p = .896) or per-protocol (91.7%, 90.9%, and 88.2%, p = .599) analysis among minocycline-metronidazole, minocycline-cefuroxime, and cefuroxime-metronidazole-containing bismuth quadruple therapies were statistically insignificant. The incidence of adverse events (35.1%, 22.6%, and 28.9%) and compliance (90.5%, 91.8%, and 91.9%) were similar. Taste distortion, nausea, and anorexia were more common in metronidazole-containing regimens, and dizziness was more common in minocycline-containing regimens. The allergy was rare (~3%).. The efficacies of three bismuth quadruple therapies containing minocycline, cefuroxime, and full-dose metronidazole (pairwise) for first-line H. pylori eradication in penicillin-allergic patients were similarly satisfactory with relatively good safety and compliance. The study was registered in the Chinese Clinical Trials Registration (ChiCTR1900023702).

Topics: Amoxicillin; Anti-Bacterial Agents; Bismuth; Cefuroxime; Drug Therapy, Combination; Helicobacter Infections; Helicobacter pylori; Humans; Hypersensitivity; Medication Adherence; Metronidazole; Minocycline; Penicillins; Tetracycline; Treatment Outcome

Given the general unavailability, common adverse effects, and complicated administration of tetracycline, the clinical application of classic bismuth quadruple therapy (BQT) is greatly limited. Whether minocycline can replace tetracycline for Helicobacter pylori ( H . pylori ) eradication is unknown. We aimed to compare the eradication rate, safety, and compliance between minocycline- and tetracycline-containing BQT as first-line regimens.. This randomized controlled trial was conducted on 434 naïve patients with H . pylori infection. The participants were randomly assigned to 14-day minocycline-containing BQT group (bismuth potassium citrate 110 mg q.i.d., esomeprazole 20 mg b.i.d., metronidazole 400 mg q.i.d., and minocycline 100 mg b.i.d.) and tetracycline-containing BQT group (bismuth potassium citrate/esomeprazole/metronidazole with doses same as above and tetracycline 500 mg q.i.d.). Safety and compliance were assessed within 3 days after eradication. Urea breath test was performed at 4-8 weeks after eradication to evaluate outcome. We used a noninferiority test to compare the eradication rates of the two groups. The intergroup differences were evaluated using Pearson chi-squared or Fisher's exact test for categorical variables and Student's t -test for continuous variables.. As for the eradication rates of minocycline- and tetracycline-containing BQT, the results of both intention-to-treat (ITT) and per-protocol (PP) analyses showed that the difference rate of lower limit of 95% confidence interval (CI) was >-10.0% (ITT analysis: 181/217 [83.4%] vs . 180/217 [82.9%], with a rate difference of 0.5% [-6.9% to 7.9%]; PP analysis: 177/193 [91.7%] vs . 176/191 [92.1%], with a rate difference of -0.4% [-5.6% to 6.4%]). Except for dizziness more common (35/215 [16.3%] vs . 13/214 [6.1%], P = 0.001) in minocycline-containing therapy groups, the incidences of adverse events (75/215 [34.9%] vs . 88/214 [41.1%]) and compliance (195/215 [90.7%] vs . 192/214 [89.7%]) were similar between the two groups.. The eradication efficacy of minocycline-containing BQT was noninferior to tetracycline-containing BQT as first-line regimen for H . pylori eradication with similar safety and compliance.. ClinicalTrials.gov, ChiCTR 1900023646.

Topics: Amoxicillin; Anti-Bacterial Agents; Bismuth; Drug Therapy, Combination; Esomeprazole; Helicobacter Infections; Helicobacter pylori; Humans; Metronidazole; Minocycline; Potassium Citrate; Tetracycline

To compare the efficacy and tolerability of minocycline vs. tetracycline in bismuth-containing quadruple therapy for Helicobacter pylori (H. pylori) rescue treatment.. This study was a multi-center, randomized-controlled, non-inferiority trial. Refractory H. pylori-infected subjects with multiple treatment-failure were randomly (1:1) allocated to receive 14-day therapy with esomeprazole 20 mg b.i.d, bismuth 220 mg b.i.d, plus metronidazole 400 mg q.i.d and minocycline 100 mg b.i.d (minocycline group) or tetracycline 500 mg q.i.d (tetracycline group). Primary outcome was H. pylori eradication rate evaluated by. Three hundred and sixty-eight subjects were randomized. The eradication rates in minocycline group and tetracycline group were 88.0% (162/184, 95% CI 83.3-92.8%) and 88.6% (163/184, 95% CI 83.9-93.2%) in intention-to-treat analysis, 98.0% (149/152, 95% CI 95.8-100%) and 97.4% (150/154, 95% CI 94.9-99.9%) in per-protocol analysis, 93.1% (162/174, 95% CI 89.3-96.9%) and 93.1% (163/175, 95% CI 89.4-96.9%) in modified intention-to-treat analysis. Minocycline, tetracycline and metronidazole resistance rates were 0.7%, 1.4% and 89.6%, respectively. Non-inferiority of minocycline was confirmed (P < 0.025). Metronidazole resistance did not affect the efficacy of either therapy. The two therapies exhibited comparable frequencies of adverse events (55.4% vs. 53.3%); almost half of them were mild. Dizziness was the most common adverse events in the minocycline group.. Minocycline can be an alternative for tetracycline in bismuth-containing quadruple therapy for H. pylori empirical rescue treatment, irrespective of metronidazole resistance. However, relatively high incidence of adverse events in both regimens should be emphasized.

Topics: Amoxicillin; Anti-Bacterial Agents; Bismuth; Drug Therapy, Combination; Helicobacter Infections; Helicobacter pylori; Humans; Metronidazole; Minocycline; Proton Pump Inhibitors; Tetracycline; Treatment Outcome

The aim of this study was to compare the efficacy and safety of ilaprazole and esomeprazole both in initial treatment regimen and retreatment regimen of H. pylori infection in chronic gastritis and to explore risk factors for eradication failure. A total of 330 patients with chronic gastritis who were confirmed of H. pylori infection were enrolled in this study. 290 of them were initially treated patients and the 40 remained were patients with retreatment. Eradication assessment was performed at least four weeks after the completion of eradication therapy. Results showed that the eradication rates of the ilaprazole group and esomeprazole group were 91.4 % and 88.4 % for per-protocol (PP) analysis (p=0.41) and 89.0 % and 86.2 % for intention-to-treat (ITT) analysis (p=0.48) in initially treated patients. Meanwhile, they were 75.0 % and 72.2 % for PP analysis (p=0.85) and 75.0 % and 70.0 % for ITT analysis (p=0.72) in patients with retreatment. The differences were not statistically significant. There was also no significant difference in safety between the two drugs. A multiple logistic regression analysis showed that demographic factors such as age, gender, alcohol, smoking, coronary heart disease (CHD), hypertension (HTN) and diabetes mellitus (DM) did not affect eradication rates. However, patients with higher DOB values and patients with atrophic gastritis had significantly lower eradication rates than patients with lower DOB values and with non-atrophic gastritis whether the proton pump inhibitor (PPI) in eradication regimens was ilaprazole or esomeprazole. In conclusion, our findings suggest that the efficacy and safety of ilaprazole and esomeprazole were not significantly different both in initial treatment regimen and retreatment regimen of H. pylori infection in chronic gastritis and DOB values and type of chronic gastritis were to be independent risk factors for eradication failure. In addition, we discovered that a new quadruple regimen containing furazolidone and minocycline which achieved good efficacy and safety can be a promising option for retreatment of H. pylori infection.

Topics: 2-Pyridinylmethylsulfinylbenzimidazoles; Adult; Anti-Bacterial Agents; Chronic Disease; Drug Therapy, Combination; Esomeprazole; Female; Furazolidone; Gastritis; Gastritis, Atrophic; Helicobacter Infections; Helicobacter pylori; Humans; Male; Middle Aged; Minocycline; Prospective Studies; Proton Pump Inhibitors; Retreatment; Treatment Failure; Treatment Outcome

To compare eradication rates, safety and compliance of minocycline quadruple and tailored therapies in patients retreated for Helicobacter pylori (H.pylori) infection.. Between January 2014 and June 2014, 135 patients with dyspepsia (18-70 years) and H. pylori infection after at least one previous eradication treatment at a tertiary hospital were randomly assigned to a 10-day treatment with minocycline quadruple therapy versus tailored triple regimen of PPI, amoxicillin and a third antibiotic. In the group of tailored therapy, medications were adjusted based on clarithromycin sensitivity and cytochrome P450 isoenzyme 2C19 genotype. Eradication status was assessed 4-12 weeks after treatment.. Although H. pylori eradication rates were higher in the minocycline therapy group than that in the tailored therapy group in intention-to-treat [84.1% (95%CI 75.0%-93.2%) vs 75.8%(95%CI 65.1%-86.5%), P=0.245] and per-protocol [88.3% (95%CI 80.3%-96.3%) vs 79.7%(95%CI 69.7%-89.7%), P=0.197] analyses, the differences between the two groups were not statistically significant.The incidence of adverse effects and compliance between the two groups were also comparable.. The tailored therapy in this study had a poor eradication efficacy in the retreated patients with H. pylori infection.Minocycline quadruple therapy achieved a relatively satisfactory eradication efficacy and may be an alternative choice for the retreatment of H. pylori infection.. Chinese Clinical Trial Registry, ChiCTR-TRC-13003975.

Topics: Amoxicillin; Anti-Bacterial Agents; Asian People; Clarithromycin; Colony Count, Microbial; Cytochrome P-450 CYP2C19; Cytochrome P-450 CYP3A Inhibitors; Drug Therapy, Combination; Dyspepsia; Female; Genotype; Helicobacter Infections; Helicobacter pylori; Humans; Microbial Sensitivity Tests; Minocycline; Retreatment; Time Factors; Treatment Outcome

Antibiotic resistance is the main reason for failure of Helicobacter pylori (H. pylori) treatment. Currently, guidelines recommend a treatment guided by antimicrobial susceptibility testing after two failures. However, microbial culture is not feasible everywhere, and the limited number of effective antibiotics against the bacterium narrows the options; thus a rescue therapy combining antibiotics with a low resistance may be fitting.. Patients who have failed a first-line treatment (either prolonged triple or sequential regimens) and, successively, a levofloxacin-based triple therapy were considered for the study. Subjects underwent urea breath test (UBT), stool antigen test (ST) and endoscopy/histology to confirm the diagnosis. Cytopenia and impaired liver and kidney function were exclusion criteria. Fifty-four subjects were randomized 1:1 to two regimens: RMB Rabeprazole/Rifabutin/Minocycline/Bismuth sub-citrate or MTB Rabeprazole/Tinidazole/Minocycline/Bismuth sub-citrate both for 10 days. The results were checked 6 weeks after the end of therapy with ST/UBT plus endoscopy when indicated.. RMB eradicated the bacterium in 21 patients. Two subjects dropped out. The eradication rate was 77.7% (CI 62.0-93.4%) at intention-to-treat and 84.0% (CI 69.6-98.4%) at per-protocol analysis. MTB was successful in 14 patients (51.9%, CI 33.1-70.7%). No patient withdrew from the treatment for adverse events. Drug-related side effects were reported only in 3 subjects, but in all cases the treatment was carried on.. The association minocycline/rifabutin seems to have a synergic effect and a good therapeutic outcome in patients who have failed at least two previous regimens, although a trial on a large population is needed.

Topics: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Breath Tests; Drug Resistance, Bacterial; Drug Therapy, Combination; Endoscopy, Gastrointestinal; Feces; Female; Helicobacter Infections; Helicobacter pylori; Humans; Italy; Male; Middle Aged; Minocycline; Organometallic Compounds; Proton Pump Inhibitors; Rabeprazole; Rifabutin; Time Factors; Tinidazole; Treatment Failure; Young Adult

Widespread use of eradication therapy for Helicobacter pylori has increased the prevalence of clarithromycin-resistant strains. The purpose of the present paper was to measure the in vitro antibacterial activity of minocycline against H. pylori, and study the effectiveness of minocycline-based first- and second-line eradication therapies.. For first-line therapy, 79 patients were randomly assigned to the treatment with rabeprazole, amoxicillin, and clarithromycin or with rabeprazole, amoxicillin, and minocycline. For second-line therapy, 88 patients were tested for sensitivity to metronidazole: 67 patients with metronidazole-sensitive strains received a 7-day course of rabeprazole, minocycline, and metronidazole; the remaining 21 patients were given a 7-day course of rabeprazole, minocycline, and faropenem.. There was virtually no resistance to minocycline among the strains tested. The eradication rate of H. pylori infection in first-line therapy was significantly lower for minocycline-containing regimen (38.5%, 15/39) than for clarithromycin-containing regimen (82.5%, 33/40; P < 0.01). For second-line therapy, a high eradication rate against metronidazole-sensitive strains was obtained with rabeprazole, minocycline and metronidazole (85%, 57/67).. A combination of rabeprazole, minocycline, and metronidazole is safe and effective for second-line therapy of H. pylori infection. Because this regimen can be administered to patients with penicillin allergy and patients who suffer adverse reactions to amoxicillin, such as diarrhea and other digestive symptoms, it should be considered useful for second- and third-line eradication therapy.

Topics: 2-Pyridinylmethylsulfinylbenzimidazoles; Amoxicillin; Anti-Bacterial Agents; Anti-Ulcer Agents; Benzimidazoles; Clarithromycin; Drug Therapy, Combination; Female; Gastritis; Helicobacter Infections; Helicobacter pylori; Humans; Male; Metronidazole; Microbial Sensitivity Tests; Middle Aged; Minocycline; Omeprazole; Peptic Ulcer; Rabeprazole; Treatment Outcome

Topics: 2-Pyridinylmethylsulfinylbenzimidazoles; Amoxicillin; Antacids; Anti-Bacterial Agents; Bismuth; Drug Therapy, Combination; Enzyme Inhibitors; Helicobacter Infections; Helicobacter pylori; Humans; Lansoprazole; Metronidazole; Minocycline; Omeprazole; Patient Compliance; Proton Pump Inhibitors; Treatment Outcome

Helicobacter pylori (H. pylori) infection is associated with remodeling of gut microbiota. Many studies have found H. pylori infection and eradication therapy can alter the gut microbiota. However, few studies explored the impact of eradication therapy containing minocycline and metronidazole on gut microbiota.. The objective of the present study was to explore the changes of gut microbiota after H. pylori infection. Besides, learn more about the dynamic changes of gut microbiota during different stages of eradication treatment containing minocycline, metronidazole, bismuth agents and proton pump inhibitors.. Sixty stool samples from the patients with H. pylori infection before eradication, 14 and 42 days after eradication, and ten stool samples from non-infected individuals were collected. Subsequently, we performed 16S rRNA gene amplicon sequencing to analyze these samples, and the results were evaluated by using alpha diversity, beta diversity and microbial composition analyses. Phylogenetic Investigation of Communities by Reconstruction of Unobserved States was also used to predict the metabolic pathways according to the Kyoto Encyclopedia of Genes and Genomes database.. The alpha and beta diversity of the microbiota changed significantly in H. pylori infected individuals, but returned to baseline 42 days after eradication therapy. At the genus level, the abundances of Bacteroidetes, [Ruminococcus]_gnavus_group, Ruminococcaceae_Incertae_Sedis, Tuzzrealla, Butyricicoccus were significantly lower in the H. pylori infected group. Bacterial abundance was also dynamically changing during eradication treatment. In addition, PICRUST analysis found the levels of uronic acid metabolism, uncharacterized transport system, and biosynthesis of unsaturated fatty acids were higher in H. pylori infected individuals than in the non-infected group.. Intestinal microbiota diversity, composition, functional predictions altered significantly after H. pylori infection, and gradually returned to healthy control levels after the application of eradication therapy containing minocycline and metronidazole in one month and a half.

Topics: Anti-Bacterial Agents; Drug Therapy, Combination; Gastrointestinal Microbiome; Helicobacter Infections; Helicobacter pylori; Humans; Metronidazole; Minocycline; Phylogeny; RNA, Ribosomal, 16S

A 63-year-old man with follicular lymphoma was administered standard R-CHOP chemotherapy. Six days after the second course of chemotherapy, the patient developed fever and chills. Blood cultures yielded rod-shaped gram-negative bacteria, but no further identification was obtained. High fever and chills returned on the fifth and sixth days after the third and fourth courses of R-CHOP, respectively. These blood cultures were also positive. Since we detected spiral-shaped gram-negative rods, we performed a prolonged culture during the febrile period after the fourth course of R-CHOP. This revealed the formation of characteristic film-like colonies, and Helicobacter cinaedi(H. cinaedi)bacteria was identified. After final identification, the patient was administered prophylactic minocycline treatment. Subsequent blood cultures were negative, fever did not recur, and we were able to complete 6 courses of R-CHOP. Although H. cinaedi has been reported to be a cause of sepsis in immunocompromised patients, standard correlation has not been established. Our case suggests that H. cinaedi should be considered when recurrent fever is observed after chemotherapy. Prophylactic antibiotic treatment with minocycline may prevent sepsis, as observed in our case.

Topics: Anti-Bacterial Agents; Bacteremia; Helicobacter Infections; Humans; Lymphoma, Follicular; Male; Middle Aged; Minocycline; Recurrence; Sepsis

Topics: Agammaglobulinemia; Anti-Bacterial Agents; Diagnosis, Differential; Helicobacter; Helicobacter Infections; Humans; Immunocompromised Host; Leg; Male; Middle Aged; Minocycline; Pyoderma Gangrenosum

Whether minocycline can replace tetracycline in Helicobacter pylori (H. pylori) eradication remains unclear. The aim of this study was to determine the efficacy, safety, patient compliance and risk factors of a combination regimen of esomeprazole, minocycline, metronidazole and bismuth (EMMB) for H. pylori eradication.. In this prospective single-center study, 152 patients in the first-line therapy group and 64 in the second-line therapy group received EMMB therapy (esomeprazole 20 mg twice daily, minocycline 100 mg twice daily, metronidazole 400 mg four times daily and bismuth potassium citrate 110 mg four times daily) for 14 days. The eradication outcome was assessed by (13) C-urea breath test 6-12 weeks after treatment.. EMMB therapy achieved eradication rates of 85.5% [95% confidence interval (CI) 79.6-91.4%] using intention-to-treat (ITT) analysis, 90.3% (95% CI 84.7-95.1%) using modified intention-to-treat (mITT) analysis and 92.6% (95% CI 88.1-96.3%) using per-protocol (PP) analysis as the first-line therapy; and 82.8% (95% CI 71.9-90.6%), 86.9% (95% CI 77.1-95.1%) and 89.5% (95% CI 80.7-96.5%) as the second-line therapy, respectively. In the first-line group, 35.6% of the patients experienced adverse effects, 4.7% discontinued medications because of adverse effects and good compliance was achieved in 91.3%, while the results were 36.5%, 3.2% and 90.5% in the second-line therapy group. Poor compliance was identified as an independent predictor of treatment failure.. The efficacy of EMMB therapy for H. pylori eradication as first-line and second-line regimens in a region with high rates of antibiotic resistance is satisfactory with relatively good patient compliance and high safety.

Topics: Adult; Aged; Anti-Bacterial Agents; Anti-Ulcer Agents; Breath Tests; Confidence Intervals; Drug Administration Schedule; Drug Therapy, Combination; Esomeprazole; Female; Helicobacter Infections; Helicobacter pylori; Humans; Intention to Treat Analysis; Male; Middle Aged; Minocycline; Patient Compliance; Peptic Ulcer; Prospective Studies; Tetracycline

Because of general unavailability of tetracycline, common adverse effects, and complicated administration, the clinical application of bismuth quadruple therapy often faces difficulties. Whether the combination of minocycline and amoxicillin can replace tetracycline and metronidazole for Helicobacter pylori eradication remains unclear. This study was to determine the efficacy, compliance, and safety of rabeprazole, minocycline, amoxicillin, and bismuth (RMAB) therapy as first-line and second-line regimens.. Between July 2013 and December 2015, a total of 160 patients in first-line and 70 patients in second-line therapies received rabeprazole 10 mg, minocycline 100 mg, amoxicillin 1000 mg, and bismuth potassium citrate 220 mg twice daily for 14 days. Eradication status was assessed 6-12 weeks after treatment.. RMAB therapy achieved the eradication rates of 87.5% (95% confidence interval, 81.9-92.5%, intention-to-treat analysis), 90.9% (85.7-95.5%, modified intention-to-treat analysis), and 92.6% (88.5-96.6%, per-protocol analysis) in first-line therapy in a setting with high antibiotic resistance rates (amoxicillin 3.4%, clarithromycin 39.7%, metronidazole 60.3%, levofloxacin 36.2%, tetracycline 3.4%, and minocycline 6.9%). As for second-line therapy, the eradication rates were 82.9% (74.3-91.4%, intention-to-treat analysis), 86.6% (77.6-94.0%, modified intention-to-treat analysis), and 89.1% (81.3-95.3%, per-protocol analysis). Totally, 24.0% patients had adverse effects, 2.2% discontinued medications, and good compliance was achieved in 94.7%. Poor compliance and minocycline resistance were identified as the risk factors for treatment failure. Significant differences in efficacy existed among the groups of both sensitive (48/51 and 18/20), isolated amoxicillin resistance (1/1 and 0/0), isolated minocycline resistance (2/3 and 1/1), and dual resistance (0/1 and 0/1) in both first-line (p = .004) and second-line (p = .035) therapies.. The eradication efficacies of RMAB therapy as first-line and second-line regimens were satisfactory with good compliance and safety in a region with high antibiotic resistance.

Topics: Adult; Amoxicillin; Anti-Bacterial Agents; Anti-Ulcer Agents; Bismuth; Drug Therapy, Combination; Drug-Related Side Effects and Adverse Reactions; Female; Helicobacter Infections; Humans; Male; Medication Adherence; Middle Aged; Minocycline; Prospective Studies; Rabeprazole; Treatment Outcome

Antibiotic resistance to Helicobacter pylori (H. pylori) has been increasing worldwide. The study aimed to evaluate in vitro susceptibility and resistance patterns to antibiotics in empirical H. pylori eradication regimens, and to determine the optimal antibiotics for treatment.. H. pylori strains (n =181) were obtained from gastric biopsies of patients with upper gastrointestinal symptoms who underwent esophagogastroduodenoscopy from March to December 2013. The susceptibility of H. pylori strains to amoxicillin (AMX), metronidazole (MTZ), clarithromycin (CLR), amoxicillin-clavulanate (AMC), cephalothin (CEP), cefuroxime (CXM), cefixime (CFM), moxifloxacin (MFX) and minocycline (MNO) was determined.. Dual resistance to MTZ + CLR was detected in 48 (26.5%) isolates, MTZ + MFX in 94 (51.9%), and CLR + MFX in 49 (27.1%). Overall, 41 (22.7%) were resistant to MTZ + CLR + MFX. MTZ and CLR resistance rates were significantly associated with the history of H. pylori eradication but there was no significant difference in MFX resistance rates between treated and untreated patients (P = 0.674). No significant relationship was found between antibiotic resistance and patient's gender, age, endoscopic findings, inflammatory severity or gastric atrophy.. AMX, AMC, MNO and cephalosporins, but not MTZ, CLR and MFX, showed good in vitro anti-H. pylori activity. Among cephalosporins, CXM was the most active. H. pylori resistance is higher in patients with previous H. pylori eradication.

Topics: Adult; Aged; Anti-Bacterial Agents; Cephalosporins; Clarithromycin; Drug Resistance, Bacterial; Drug Resistance, Multiple, Bacterial; Female; Fluoroquinolones; Gastritis; Helicobacter Infections; Helicobacter pylori; Humans; Male; Metronidazole; Microbial Sensitivity Tests; Middle Aged; Minocycline; Moxifloxacin; Peptic Ulcer; Risk Factors; Young Adult

In 2008, a 44-year-old woman with mild epigastralgia diagnosed as having Helicobacter pylori-positive chronic gastritis without peptic ulcer underwent eradication therapy with lansoprazole (LPZ), amoxicillin (AMPC) and clarithromycin (CAM) for 7 days, but it failed, so treatment with rabeprazole, AMPC, and metronidazole (MNZ) for another 7 days was given, but it also failed. She was then prescribed a modified, 14-day sequential therapy of LPZ and AMPC with an increased dose of CAM followed by MNZ supplement, but the infection was still not eradicated. The H. pylori was cultured and examined for antibiotic susceptibility with the agar dilution method and was found to be resistant to CAM, MNZ, and levofloxacin, and non-sensitive to AMPC, namely multiple-antibiotic-resistant, although sensitive to minocycline. The CYP2C19 genotype of the patient was an extensive metabolizer (G681A: G/A, G636A: G/G). In 2010, she gave informed consent for a 14-day, tailor-made, modified classical (or modified high-dose PPI + AMPC) quadruple therapy comprising 30 mg LPZ, 500 mg AMPC and 500 mg bismuth subnitrate, qid, and 100 mg minocycline, bid. Two months later, her urea breath test was negative. Histology and bacterial culture were still negative 1 year after the therapy. She did not have any adverse events during or after the novel therapy, nor did she feel any further epigastralgia.

Topics: 2-Pyridinylmethylsulfinylbenzimidazoles; Adult; Amoxicillin; Antacids; Anti-Bacterial Agents; Aryl Hydrocarbon Hydroxylases; Bismuth; Breath Tests; Cytochrome P-450 CYP2C19; Drug Administration Schedule; Drug Resistance, Multiple, Bacterial; Drug Therapy, Combination; Female; Gastritis; Genotype; Helicobacter Infections; Helicobacter pylori; Humans; Lansoprazole; Microbial Sensitivity Tests; Minocycline; Phenotype; Proton Pump Inhibitors; Time Factors

The minimum inhibitory concentrations (MICs) of 330 nonduplicate Helicobacter pylori isolates to nemonoxacin, tigecycline, and eight other antimicrobial agents were determined by using the agar dilution method. Sequencing the quinolone resistance-determining regions (QRDRs) in the gyrA gene of these isolates was also performed. Resistance to clarithromycin showed an increasing trend during the ten-year study period and was highest (38%) in 2005. Tigecycline had potent in vitro activities against all isolates, with an MIC(90) of 0.06 μg/ml. Among the quinolones tested, nemonoxacin (MIC(50) of 0.12 μg/ml and MIC(90) of 0.25 μg/ml) and gemifloxacin had one to two-fold better in vitro activities than ciprofloxacin, levofloxacin, and moxifloxacin. Among the nine isolates (2.7%) with levofloxacin resistance, four (44.4%) were also resistant to metronidazole, three (33.3%) to clarithromycin, and two (22.2%) to amoxicillin. Isolates with levofloxacin resistance exhibited one or two of three amino acid alterations (Ser-70, Asn-87, and Asp-91) involved in QRDRs in the gyrA gene. A double mutation at Ser70Cys and Asn87Ile had a higher level of resistance. The results of this study suggest a potentially useful role of nemonoxacin and tigecycline in the treatment of infections caused by H. pylori. The gyrA mutation at Ser-70 is a novel finding and has an impact on levofloxacin resistance.

Topics: Amino Acid Substitution; Amoxicillin; Anti-Bacterial Agents; Aza Compounds; Ciprofloxacin; Clarithromycin; DNA Gyrase; Drug Resistance, Multiple, Bacterial; Fluoroquinolones; Gemifloxacin; Helicobacter Infections; Helicobacter pylori; Humans; Levofloxacin; Metronidazole; Microbial Sensitivity Tests; Minocycline; Moxifloxacin; Mutation; Naphthyridines; Ofloxacin; Quinolines; Quinolones; Sequence Analysis, Protein; Taiwan; Tetracyclines; Tigecycline

A 52-year-old Japanese woman was referred to our Institute because of Helicobacter pylori(H. pylori)-positive gastric mucosa-associated lymphoid tissue(MALT)lymphoma. Since she had a penicillin allergy, we could not eradicate H. pylori using the standard triple therapy including amoxicillin. Additionally, H. pylori was resistant to both clarithromycin and metronidazole. So she was treated with minomycin (MINO), levofloxacin (LVFX), and rabeprazole (RPZ) based on a drug sensitivity test. MINO+LVFX+RPZ appear to be a promising, appropriate, and well-tolerated eradication regimen for H. pylori demonstrating resistance to both clarithromycin and metronidazole, and for patients who are allergic to penicillin.

Topics: 2-Pyridinylmethylsulfinylbenzimidazoles; Biopsy; Drug Hypersensitivity; Female; Helicobacter Infections; Helicobacter pylori; Humans; Levofloxacin; Lymphoma, B-Cell, Marginal Zone; Middle Aged; Minocycline; Ofloxacin; Penicillins; Rabeprazole

Recent studies have shown that the combination of proton pump inhibitor, amoxicillin and clarithromycin is one of the best choices for Helicobacter pylori eradication therapy. However, increasing number of cases of H. pylori infection showing resistance to clarithromycin therapy has been reported and this is currently the main cause of eradication failure. We investigated the annual changes of the antimicrobial susceptibility to clarithromycin, amoxicillin and minocycline during a period of 12 years in Japan.. This study comprised 3521 patients (mean age (SD), 55.4 (13.7) years-old, 2467 males and 1054 females) positive for H. pylori as assessed by microaerobic bacterial culture from 1996 through 2008. All patients were previously untreated for H. pylori and were enrolled in the study to assess primary resistance to the three antibiotics.. The overall primary resistance to clarithromycin, amoxicillin and minocycline were 16.4%, (577/3521), 0.03% (1/3521) and 0.06% (2/3521), respectively. From 1996 through 2004, the resistance rate to clarithromycin increased gradually to approximately 30% and then it remained without marked fluctuation since 2004. Analysis by gender showed a significant increase (p < .0001) in resistance rate to clarithromycin among females (217/1057, 20.6%) compared to males (360/2467, 14.6%). Analysis by age, disclosed significantly (p < .0001) higher resistance rate to clarithromycin in patients of more than 65-years-old compared to the younger population.. The resistance rate of H. pylori infection to clarithromycin in Japan has increased gradually to approximately 30% from 1996 through 2004, and remained unchanged since 2004. Elderly and females were at high risk of having resistance to clarithromycin. Our results suggested that the level of clarithromycin resistance in Japan has now risen to the point where it should no longer be used as empiric therapy.

Topics: Adult; Age Factors; Aged; Amoxicillin; Anti-Bacterial Agents; Clarithromycin; Drug Resistance, Bacterial; Female; Helicobacter Infections; Helicobacter pylori; Humans; Japan; Male; Middle Aged; Minocycline

This report focuses on a 59-year-old male Japanese patient with Ménétrier's disease who suffered from severe hypoproteinemia and tested positive for Helicobacter pylori when initially admitted to hospital. Blood levels of intact glucagon-like peptide-2 (GLP-2) were determined by specific bioassay, using serum-induced cAMP production in COS-7 cells expressing recombinant human GLP-2 receptors as a functional readout. Eradication of H. pylori led to remission of Ménétrier's disease as well as a partial yet significant decrease in GLP-2 levels, and also improved hypoproteinemia. These observations suggest a possible link between excess systemic endogenous production of GLP-2, a gut hormone that induces mucosal growth, and the hypertrophic gastropathy in a Ménétrier's disease patient with H. pylori infection.

Topics: 2-Pyridinylmethylsulfinylbenzimidazoles; Amoxicillin; Anti-Bacterial Agents; Anti-Ulcer Agents; Gastritis, Hypertrophic; Glucagon-Like Peptide 2; Glucagon-Like Peptides; Helicobacter Infections; Helicobacter pylori; Humans; Lansoprazole; Male; Middle Aged; Minocycline; Omeprazole; Peptides; Remission Induction

We report on case of a 52-year-old male with refractory idiopathic thrombocytopenic purpura. Treatment with prednisolone, vincristine, azathioprine, colchicine, danazol, diaphenylsulfone, and splenectomy were tried but all were ineffective and platelet counts mostly stayed below 5,000/microliter. We finally tried eradicating Helicobacter pylori (HP) with the standard combination of amoxicillin (1,500 mg), clarithromycin (400 mg), and lansoprazole (60 mg) for 7 days, but it failed. We therefore gave the patient a second eradication therapy based upon a drug sensitivity test using HP obtained from his gastric mucosa. According to the drug sensitivity test, we treated him with minocycline (200 mg), levofloxacin (600 mg), and lansoprazole (60 mg) for 7 days. The platelet counts increased gradually and reached to 30,000/microliter after the eradication, and the patient was spared extended hospitalization.

Topics: 2-Pyridinylmethylsulfinylbenzimidazoles; Anti-Bacterial Agents; Helicobacter Infections; Helicobacter pylori; Humans; Lansoprazole; Levofloxacin; Male; Microbial Sensitivity Tests; Middle Aged; Minocycline; Ofloxacin; Omeprazole; Platelet Count; Purpura, Thrombocytopenic, Idiopathic

Topics: 2-Pyridinylmethylsulfinylbenzimidazoles; Anti-Bacterial Agents; Blood Platelets; Drug Therapy, Combination; Helicobacter Infections; Helicobacter pylori; Humans; Lansoprazole; Male; Middle Aged; Minocycline; Ofloxacin; Omeprazole; Platelet Count; Purpura, Thrombocytopenic, Idiopathic

Emergence of antibiotic resistant Helicobacter pylori has necessitated the identification of alternate therapies for the treatment of this infection.. To assess the in vitro efficacy of two investigational agents: DMG-MINO CL 344 (a N,N-dimethylglycylamido derivative of minocycline), and davercin, a cyclic carbonate of erythromycin A as compared to older antibiotics (clarithromcyin, azithromycin, minocycline, tetracycline, ofloxacin, ciprofloxacin, cefixime) against clinical isolates of H. pylori.. Testing was performed using the agar dilution method approved by the NCCLS subcommittee on antimicrobial susceptibility testing, Helicobacter pylori working group. Under these guidelines, Mueller-Hinton agar containing 5% aged sheep blood was used. All incubations were done under CampyPak Plus conditions for 72 h at 37 degrees C. The drug concentrations in the agar ranged from 0.016 to 16 microg/mL. Twenty-one clarithromycin-resistant and 16 clarithromycin-susceptible clinical isolates of H. pylori obtained from patients with duodenal ulcer were used. H. pylori ATCC 43504 was used as the control in all determinations.. Against clarithromycin susceptible isolates, all antimicrobial agents except the fluoroquinolones were highly effective. Against clarithromycin-resistant H. pylori, the MIC50/MIC90 values showed that the tetracyclines and cefixime were the most efficacious agents. The fluoroquinolones and macrolides were ineffective. Macrolide cross-resistance was detected.. Macrolide cross-resistance prevents the use of this entire class of antimicrobials when clarithromycin resistance is present. Tetracyclines and cefixime are possible alternative agents for the treatment of H. pylori infection in these patients.

Topics: Anti-Bacterial Agents; Drug Resistance, Microbial; Erythromycin; Helicobacter Infections; Helicobacter pylori; Humans; Microbial Sensitivity Tests; Minocycline