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Rifabutin-based rescue therapy constitutes an encouraging strategy after multiple previous eradication failures with key antibiotics such as amoxicillin, clarithromycin, metronidazole and tetracycline.
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Eradication of H. pylori provides a potential cure in the majority of patients with gastric ulcer as well as duodenal ulcer. Two proton pump inhibitor(PPI)-based triple therapy, combining with clarithromycin(CAM), amoxicillin(AMPC) or metronidazole have been established as standard regimens worldwide. In Japan, lansoprazole(LPZ)-based triple therapy combined with CAM and AMPC for 1 week was firstly investigated on eradication effect against H. pylori and determination of the optimal dose of CAM in multicenter, double-blind trial. Patients with active gastric ulcer or duodenal ulcer were enrolled in this study. The eradication rate of H. pylori in patients with gastric ulcer were 0%, 87.5% and 89.2% and those in patients with duodenal ulcer were 4.4%, 91.1% and 83.7% in LPZ(60 mg/d) alone, LPZ(60 mg/d) with CAM(400 mg/d) and AMPC(1,500 mg/d), LPZ(60 mg/d) with CAM(800 mg/d) and AMPC(1,500 mg/d), respectively, in the full set analysis. LPZ-based triple therapy demonstrated a high eradication rate and was safe. In addition, the combination regimens with lower or higher dose of CAM were equivalent in Japanese patients.
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The study included 52 patients who underwent a triple therapy with PPI, clarithromycin and amoxicillin for 14 days between September 2001 and December 2002, and were found to be resistant to the therapy. They were randomized to take ranitidine bismuth citrate (Rb) 400 mg twice a day, tetracycline (T) 1 g twice a day and metronidazole (M) 500 mg three times a day for 14 days (RbTM), or ranitidine bismuth citrate (Rb) 400 mg twice a day for 14 days and azithromycin (A) 500 mg once a day for 7 days (RbA). Four weeks after the treatment, endoscopies were repeated, and patients were assessed with respect to changes in symptoms. When H. pylori was negative on histological analysis and urease test, eradication was achieved.
Pouchitis is the most frequent long-term complication of pouch surgery for ulcerative colitis. There is consistent evidence on the implication of bacterial flora in the pathogenesis of pouchitis, and there is evidence for a therapeutic role of antibiotics and probiotics in therapy of this disease. Antibiotics, particularly ciprofloxacin and metronidazole, are the mainstay of treatment for acute pouchitis. In chronic refractory pouchitis, after having excluded other diagnoses (infections, Crohn's disease of the pouch, ischemia and irritable pouch), antibiotic combination therapy is the treatment of choice. The highly concentrated probiotic mixture VSL#3 has been shown to be effective in prevention of pouchitis onset and in maintaining antibiotic-induced remission.
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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.
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The activities of garenoxacin, ciprofloxacin, levofloxacin, moxifloxacin, trovafloxacin, amoxicillin-clavulanate, piperacillin-tazobactam, imipenem, clindamycin, and metronidazole against 20 anaerobes were tested. At two times the MIC, garenoxacin was bactericidal against 19 of 20 strains after 48 h and against 17 of 20 after 24 h. Other drugs, except clindamycin (which gave lower killing rates), gave killing rates similar to those for garenoxacin.
In this double-blind, multicenter parallel group comparison, H. pylori-positive patients were randomly assigned to either the PCM-7 group (7 days of pantoprazole 40 mg bid, clarithromycin 500 mg bid, metronidazole 500 mg bid) or the PCM-14 m group (modified 14 day therapy of the same regimen with metronidazole only given for 10 days due to labeling reasons). H. pylori status was determined by urease test, histology, culture, and 13C-urea breath test. Treatment outcome was assessed 6 weeks after intake of the last study medication.
Forty-two patients were treated. Their mean age was 29.44 years (standard deviation: 18.3 years) and the M/F sex ratio was 5. Skin wounds accounted for 57.1% of the portals of entry, deep wounds for 26.2%; the rest were unknown. Twenty patients (47.6%) had fever when admitted. Tetanus was generalized in all cases and 76.2% of patients were stage III. Four patients were HIV-positive. Clinical improvement, defined as a decrease in dysphagia, trismus, and paroxysm, was observed more quickly in the test group: 48 hours after treatment began, improvement was seen in more than 76% of the test group compared with 28% in the control group. In the test group, the mean hospitalization period was 7.4 days and mortality was 11.7%, compared with 19 days and a mortality rate of 52% in the control group.
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At 3 and 12 months following therapy mean PD at monitored sites in the test group changed from 6.8 mm (+/-1.3) to 3.6 mm (+/-1.0), 3.8 mm (+/-1.1) and CAL from 7.5 mm (+/-1.4) to 5.4 mm (+/-1.4), 5.5 mm (+/-1.3). In the control group PD changed from 6.5 mm (+/-0.7) to 4.0 mm (+/-1.7), 4.1 mm (+/-1.6) and CAL from 7.5 mm (+/-1.0) to 6.3 mm (+/-1.7), 6.4 mm (+/-1.8). P was <0.05 for CAL between groups. Three and 12 months following adjunctive systemic ofloxacin therapy, Aa was suppressed below detectable levels in 22 of 22, test patients, whereas Aa could not be recovered in only 2 of the 10 controls. (P<0.0001).