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Metronidazole
Published in M. Lindsay Grayson, Sara E. Cosgrove, Suzanne M. Crowe, M. Lindsay Grayson, William Hope, James S. McCarthy, John Mills, Johan W. Mouton, David L. Paterson, Kucers’ The Use of Antibiotics, 2017
In addition to clarithromycin and metronidazole, other antibiotics have been studied for the treatment of H. pylori, including bismuth, levofloxacin (Chapter 104, Levofloxacin), moxifloxacin (Chapter 105, Moxifloxacin), and furazolidone (Chapter 189, Furazolidine). A randomized study of 10 days of omeprazole plus a single three-in-one capsule containing bismuth subcitrate potassium, metronidazole, and tetracycline (quadruple therapy) versus 7 days of omeprazole, amoxicillin, and clarithromycin (standard therapy) demonstrated an eradication rate of 80% in the quadruple therapy arm versus 55% in the standard therapy arm (Malfertheiner et al., 2011). This combination drug (Pylera, Axcan Scandipharm) has been licenced by the FDA.
Understanding treatment guidelines with bismuth and non-bismuth quadruple Helicobacter pylori eradication therapies
Published in Expert Review of Anti-infective Therapy, 2018
David Y. Graham, Maria Pina Dore, Hong Lu
Pylera® is a commercial version of bismuth triple therapy in which the drugs are administered in capsules containing more than one of the drugs resulting in fewer capsules. The PPI is administered separately. Pylera® was first available in the US and has recently been approved in Europe. Pylera® was marketed as a 10-day therapy despite evidence and knowledge that for metronidazole susceptible infections a 7-day therapy is sufficient whereas for resistant infections 14-day therapy is required. The recommended Pylera® dosing results in those with susceptible infections receive too much medication and a reduction in cure rates for those with metronidazole resistant infections. The 10-day choice was likely a marketing decision based on the competition product (Helidac®) being marketed for 14 day (i.e. shorter duration, fewer tablets). There is no evidence that adherence or side effects were improved by the new formulation or that 10-day therapy was non-inferior to 14-day therapy while maintaining high cure rates [46]. Below we discuss several alternate formulations with fewer tablets and possibly improved adherence.
Single-capsule bismuth-based quadruple therapy as a rescue therapy for Helicobacter pylori eradication
Published in Scandinavian Journal of Gastroenterology, 2023
Catarina Correia, Nuno Almeida, Carina Leal, Diogo Branquinho, Alexandra Fernandes, Elisa Gravito-Soares, Carlos Calhau, Isabel Bastos, Helena Vasconcelos, Pedro Figueiredo
After assessment of H. pylori infection, all patients were treated for 10 days with a combined formulation containing PPI twice a day (30 min before breakfast and dinner) plus three capsules of Pylera® (each one containing bismuth subcitrate potassium 140 mg, metronidazole 125 mg, and tetracycline 125 mg) four times a day. Patients were strongly encouraged to comply fully. Patients were asked to refrain from consuming alcohol during the entire treatment period and they were instructed not to take drugs with milk or other dairy products and to avoid sunbathing.
Multidrug resistance in Helicobacter pylori: current state and future directions
Published in Expert Review of Clinical Pharmacology, 2019
Lyudmila Boyanova, Petyo Hadzhiyski, Nayden Kandilarov, Rumyana Markovska, Ivan Mitov
Pylera®, a three-in-one capsule (metronidazole 125 mg, tetracycline 125 mg, and bismuth subcitrate 140 mg) can be used in combination with double-dose PPIs [47]. Regardless of PPI dose and type, eradication success of PPI/Pylera therapy was ≥90% in infections with metronidazole resistant strains as well as second-line therapy following clarithromycin-based regimens [48].