Zusammenfassung
Hintergrund und Ziele: In Europa sind Infektionen mit Mycobacterium (M.) marinum selten. Wir führten eine retrospektive Studie durch, um klinisches Spektrum sowie Diagnostik, Therapie ...und Ergebnisse von M.‐marinum‐Infektionen unter praxisnahen Bedingungen zu analysieren.
Patienten und Methodik: In der Datenbank des Universitätsklinikums Würzburg wurden zwischen 1998 und 2018 18 Patienten mit M.‐marinum‐Infektionen identifiziert.
Ergebnisse: Zwölf Betroffene berichteten über eine Exposition gegenüber Zierfischaquarien oder Teichen. Sechzehn Patienten präsentierten Hautläsionen an den oberen Extremitäten. Es wurden keine invasiven Infektionen beobachtet. Der durchschnittliche Zeitraum bis zur Diagnosestellung betrug 15 Wochen. Bei 14 Patienten ergab die Histologie eine granulomatöse Entzündung. In 16 Fällen gelang der kulturelle Nachweis. Die meisten Patienten erhielten eine Antibiotika‐Monotherapie (14/18), in vier Fällen wurde eine Kombinationstherapie verabreicht. Die Behandlung (mediane Dauer von 10 Wochen) war bei 13 Patienten erfolgreich. Fünf Patienten stellten sich im Therapieverlauf nicht wieder vor.
Schlussfolgerungen: Unsere retrospektive Analyse von M.‐marinum‐Infektionen an einem tertiären Referenzzentrum in Deutschland zeigte eine erhebliche zeitliche Verzögerung in der Diagnosestellung und belegt die Bedeutung von mikrobiologischer Kultur, PCR und Histologie. Eine Monotherapie mit Clarithromycin (anstelle von Doxycyclin) erwies sich als geeignet, während die Behandlung bei immunsupprimierten oder ‐geschwächten Patienten und bei ausgedehnten Befunden durch eine Kombinationstherapie ergänzt wurde.
This clinical trial was conducted to evaluate the pharmacokinetics and pharmacodynamics of tegoprazan when coadministered with amoxicillin/clarithromycin in healthy subjects. Cohort 1 was an ...open-label, randomized multiple-dose study to evaluate the mutual interaction of tegoprazan and amoxicillin/clarithromycin on the disposition of 3 tested drugs including tegoprazan M1 metabolite and 14-hydroxyclarithromycin (14-OH-clarithromycin). Cohort 2 was an open-label, randomized, active-controlled, parallel multiple-dose study to compare the intragastric pH profile after multiple oral doses of 50 or 100 mg tegoprazan coadministered with amoxicillin/clarithromycin 1000/500 mg for 7 days and pantoprazole-based triple therapy as the comparator arm. The coadministration of tegoprazan with amoxicillin/clarithromycin increased C
(2.2-fold) and AUC
(2.7-fold) of tegoprazan and M1 (2.1- and 2.2-fold for C
and AUC
, respectively) compared with administration of tegoprazan alone. The C
and AUC
of 14-OH-clarithromycin increased by 1.7- and 1.8-fold, respectively; the disposition of amoxicillin and clarithromycin were not significantly changed. On days 1 and 7 of treatment, tegoprazan-based therapies (both 50- and 100-mg therapies) maintained pH above 6 for more than 88% of the 24-hour period, which was significantly longer compared with pantoprazole-based therapy. Tegoprazan either alone or in combination with amoxicillin/clarithromycin was well tolerated in healthy subjects. In conclusion, the exposure of tegoprazan was increased after coadministration of amoxicillin/clarithromycin, which led to increase pharmacodynamic response measured by intragastric pH compared with tegoprazan alone. Therefore, tegoprazan-based triple therapy would be effective therapeutic regimen to manage intragastric pH in terms of gastric or duodenal ulcers healing, treatment of gastroesophageal reflux disease, and Helicobacter pylori eradication.
Abstract Background & aims Helicobacter pylori infection is increasingly difficult to treat. The purpose of these consensus statements is to review the literature and provide specific, updated ...recommendations for eradication therapy in adults. Methods A systematic literature search identified studies on H. pylori treatment. The quality of evidence and strength of recommendations were rated according to the Grading of Recommendation Assessment, Development, and Evaluation (GRADE) approach. Statements were developed through an online platform, finalized and voted on by an international working group of specialists chosen by the Canadian Association of Gastroenterology. Results Because of increasing failure of therapy, the consensus group strongly recommended that all H. pylori eradication regimens now be given for 14 days. Recommended first-line strategies include concomitant non-bismuth quadruple therapy (proton pump inhibitor, PPI + amoxicillin + metronidazole + clarithromycin, PAMC), and traditional bismuth quadruple therapy (PPI + bismuth + metronidazole + tetracycline, PBMT). PPI triple therapy (PPI + clarithromycin and either amoxicillin or metronidazole) was restricted to areas with known low clarithromycin resistance or high eradication success with these regimens. Recommended rescue therapies include PBMT and levofloxacin-containing therapy (PPI + amoxicillin + levofloxacin, PAL). Rifabutin regimens should be restricted to patients who fail at least 3 prior options. Conclusions Optimal treatment of H. pylori requires careful attention to local antibiotic resistance and eradication patterns. Quadruple therapies PAMC or PBMT should play a more prominent role in H. pylori eradication and all treatments should be given for 14 days.
ObjectiveTo date, no randomised trials have compared the efficacy of vonoprazan and amoxicillin dual therapy with other standard regimens for Helicobacter pylori treatment. This study aimed to ...investigate the efficacy of the 7-day vonoprazan and low-dose amoxicillin dual therapy as a first-line H. pylori treatment, and compared this with vonoprazan-based triple therapy.DesignThis prospective, randomised clinical trial was performed at seven Japanese institutions. Patients with H. pylori–positive culture test and naive to treatment were randomly assigned in a 1:1 ratio to either VA-dual therapy (vonoprazan 20 mg+amoxicillin 750 mg twice/day) or VAC-triple therapy (vonoprazan 20 mg+amoxicillin 750 mg+clarithromycin 200 mg twice/day) for 7 days, with stratification by age, sex, H. pylori antimicrobial resistance and institution. Eradication success was evaluated by 13C-urea breath test at least 4 weeks after treatment.ResultsBetween October 2018 and June 2019, 629 subjects were screened and 335 were randomised. The eradication rates of VA-dual and VAC-triple therapies were 84.5% and 89.2% (p=0.203) by intention-to-treat analysis, respectively, and 87.1% and 90.2% (p=0.372) by per-protocol analysis, respectively. VA-dual was non-inferior to VAC-triple in the per-protocol analysis. The eradication rates in strains resistant to clarithromycin for VA-dual were significantly higher than those for VAC-triple (92.3% vs 76.2%; p=0.048). The incidence of adverse events was equal between groups.ConclusionThe 7-day vonoprazan and low-dose amoxicillin dual therapy provided acceptable H. pylori eradication rates and a similar effect to vonoprazan-based triple therapy in regions with high clarithromycin resistance.Trial registration numberUMIN000034140.
Background/Aims: Compared with other regimens, concomitant therapy (CT) used as a first-line regimen for Helicobacter pylori (H. pylori) infection is associated with higher eradication rates. We ...compared the efficacy of tailored therapy (TT) using bismuth added to standard triple therapy (STT) with CT.Methods: This consecutive study performed between September 2020 and 2021 included 210 patients with H. pylori infection. Two participating gastroenterologists prescribed TT and CT. Multiplex PCR assays were performed before eradication therapy to identify the relevant point mutations and confirm clarithromycin resistance in the TT group (n=105). Patients who showed negative PCR results received 14-day STT and those with positive PCR results received a 14-day regimen of bismuth added to STT. The other group (n=105) received 10-day CT.Results: Based on per-protocol analysis, eradication rates in the TT and CT groups were 89.2% (91/102) and 81.6% (84/103), respectively. We observed no statistically significant intergroup differences in eradication rates (P=0.12). The frequency of estimated clarithromycin resistance confirmed using multiplex PCR assays was 32.4% (34/105), and the eradication rate associated with bismuth add-on STT was 76.5% (26/34) in patients with clarithromycin resistance.Conclusions: Considering the current and emerging trends in antibiotic resistance, a therapeutic strategy using TT (bismuth add-on STT) is recommended to minimize unnecessary administration of antibiotics.
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The current research aimed to explore medium chain triglycerides (MCT) incorporation in liposomes to overcome stability challenges when drugs with high molecular weight and payload ...are loaded within lipid membranes. A model drug clarithromycin was loaded in lipid dispersions with various MCT/phospholipids ratios (RM/P = 0, 0.5, 1.75 and 7.5 w/w). TEM images demonstrated a liposome-to-emulsion structural transformation by MCT incorporation to cause increased particle size (104.3–167.7 nm) but decreased zeta potential (−63.6 to −44.4 mV) of lipid particles. MCT incorporation produced biphasic release in PBS and accelerated released in plasma. The tolerance of liposomes for thermal sterilization, high temperature test and freeze-thaw cycles were significantly improved by MCT incorporation. However, MCT incorporation produced adverse effects on colloidal stability in plasma and pharmacokinetics behavior in vivo to some extent. MCT stabilizing mechanism attributes to the modulation of drug loading area and stability improvement of lipid carriers. MCT incorporated liposomes achieved 2–3 fold cellular uptake level than traditional liposomes without significant cytotoxicity. These results indicated that MCT incorporation could be a promising strategy to apply in liposome production to achieve stable drug loading.
Cutaneous adverse drug reactions (cADR) should be appropriately managed in drug administration. LANSAP
, Rabecure
and VONOSAP
are currently used for Helicobacter pylori eradication therapy. Here, we ...examined the characteristics of cADR caused by these drugs using data from the Pharmaceuticals and Medical Devices Agency (PMDA). Periods subject to analyses were set according to the year of release of these drugs: (i) from 2008 to 2017 for LANSAP; (ii) from 2014 to 2017 for Rabecure; and (iii) 2017 for VONOSAP. Among all cADR reported to the PMDA, those attributed to LANSAP, Rabecure and VONOSAP accounted for 2.3%, 1.0% and 3.6% of cases, respectively. cADR occurred in patients aged in their 20s or older, with the oldest patients aged in their 60s. Numbers of male and female patients were 28 and 70 for LANSAP, eight and 14 for Rabecure and three and 16 for VONOSAP, respectively. Statistical analyses revealed significant sex differences for LANSAP (P = 0.022) and VONOSAP (P = 0.012), but not for Rabecure (P = 0.729). LANSAP, Rabecure or VONOSAP caused erythema multiforme in the largest population of patients and Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) in three patients. Ratios of SJS/TEN were 0.0-5.3% for LANSAP, Rabecure or VONOSAP, but 11.5-44.8% for the corresponding single constituent drugs other than vonoprazan. In conclusion, female sex appears to represent a risk factor for cADR attributed to H. pylori eradication therapy using LANSAP or VONOSAP, although H. pylori eradication therapy without these drugs rarely causes severe cADR.
Managing Helicobacter pylori infection requires constant decision making, and each decision is open to possible errors.
The aim was to evaluate common mistakes in the eradication of H. pylori, based ...on the "European Registry on Helicobacter pylori management".
European Registry on Helicobacter pylori management is an international multicentre prospective noninterventional registry evaluating the decisions and outcomes of H. pylori management by European gastroenterologists in routine clinical practice.
Countries recruiting more than 1000 patients were included (26,340 patients). The most common mistakes (percentages) were: (1) To use the standard triple therapy where it is ineffective (46%). (2) To prescribe eradication therapy for only 7 to 10 days (69%). (3) To use a low dose of proton pump inhibitors (48%). (4) In patients allergic to penicillin, to prescribe always a triple therapy with clarithromycin and metronidazole (38%). (5) To repeat certain antibiotics after eradication failure (>15%). (6) Failing to consider the importance of compliance with treatment (2%). (7) Not to check the eradication success (6%). Time-trend analyses showed progressive greater compliance with current clinical guidelines.
The management of H. pylori infection by some European gastroenterologists is heterogeneous, frequently suboptimal and discrepant with current recommendations. Clinical practice is constantly adapting to updated recommendations, although this shift is delayed and slow.
IMPORTANCE Calcium-channel blockers are metabolized by the cytochrome P450 3A4 (CYP3A4; EC 1.14.13.97) enzyme. Blood concentrations of these drugs may rise to harmful levels when CYP3A4 activity is ...inhibited. Clarithromycin is an inhibitor of CYP3A4 and azithromycin is not, which makes comparisons between these 2 macrolide antibiotics useful in assessing clinically important drug interactions. OBJECTIVE To characterize the risk of acute adverse events following coprescription of clarithromycin compared with azithromycin in older adults taking a calcium-channel blocker. DESIGN, SETTING, AND PARTICIPANTS Population-based retrospective cohort study in Ontario, Canada, from 2003 through 2012 of older adults (mean age, 76 years) who were newly coprescribed clarithromycin (n = 96 226) or azithromycin (n = 94 083) while taking a calcium-channel blocker (amlodipine, felodipine, nifedipine, diltiazem, or verapamil). MAIN OUTCOMES AND MEASURES Hospitalization with acute kidney injury (primary outcome) and hospitalization with hypotension and all-cause mortality (secondary outcomes examined separately). Outcomes were assessed within 30 days of a new coprescription. RESULTS There were no differences in measured baseline characteristics between the clarithromycin and azithromycin groups. Amlodipine was the most commonly prescribed calcium-channel blocker (more than 50% of patients). Coprescribing clarithromycin vs azithromycin with a calcium-channel blocker was associated with a higher risk of hospitalization with acute kidney injury (420 patients of 96 226 taking clarithromycin 0.44% vs 208 patients of 94 083 taking azithromycin 0.22%; absolute risk increase, 0.22% 95% CI, 0.16%-0.27%; odds ratio OR, 1.98 95% CI, 1.68-2.34). In a subgroup analysis, the risk was highest with dihydropyridines, particularly nifedipine (OR, 5.33 95% CI, 3.39-8.38; absolute risk increase, 0.63% 95% CI, 0.49%-0.78%). Coprescription with clarithromycin was also associated with a higher risk of hospitalization with hypotension (111 patients of 96 226 taking clarithromycin 0.12% vs 68 patients of 94 083 taking azithromycin 0.07%; absolute risk increase, 0.04% 95% CI, 0.02%-0.07%; OR, 1.60 95% CI, 1.18-2.16) and all-cause mortality (984 patients of 96 226 taking clarithromycin 1.02% vs 555 patients of 94 083 taking azithromycin 0.59%; absolute risk increase, 0.43% 95% CI, 0.35%-0.51%; OR, 1.74 95% CI, 1.57-1.93). CONCLUSIONS AND RELEVANCE Among older adults taking a calcium-channel blocker, concurrent use of clarithromycin compared with azithromycin was associated with a small but statistically significant greater 30-day risk of hospitalization with acute kidney injury. These findings support current safety warnings regarding concurrent use of CYP3A4 inhibitors and calcium-channel blockers.
Background and Aim
The increase in antibiotic resistance makes the eradication of Helicobacter pylori more difficult. Considering the limitations of the application of susceptibility‐guided therapy, ...it is important to find an effective empirical regimen. The aim of the study is to compare the efficacy, safety, and cost‐effectiveness of clarithromycin‐based bismuth‐containing quadruple therapy (C‐BQT) and furazolidone‐based bismuth‐containing quadruple therapy (F‐BQT) in naïve H. pylori positive patients.
Methods
This was an open‐label, randomized controlled, crossover trial. The trial comprised two phases. In C‐F group, patients received C‐BQT in the first phase; those who were still positive for H. pylori infection after the first phase entered the second phase to receive F‐BQT as rescue treatment. In F‐C group, patients were treated with F‐BQT firstly and rescued with C‐BQT.
Results
As first‐line treatments, the eradication rates of C‐BQT and F‐BQT were 89.7% (157/175) and 92.0% (161/175) (P = 0.458) in intention‐to‐treat analysis and 93.4% (156/167) and 95.8% (161/168) (P = 0.327) in per‐protocol analysis, respectively. The cumulative eradication rates of the C‐F group and the F‐C group were both 94.3% in intention‐to‐treat analysis (P = 1.000). Cost‐effectiveness indexes of F‐BQT and C‐BQT were 0.54 and 1.24 in first‐line treatments. Frequencies of adverse events in F‐BQT and C‐BQT had no differences (36.0% in C‐BQT vs 32.6% in F‐BQT, P = 0.499).
Conclusions
Furazolidone‐based bismuth‐containing quadruple therapy should be preferred for its excellent cost‐effectiveness and acceptable safety.
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