Helicobacter pylori eradication therapy with a proton pump inhibitor (PPI), clarithromycin, and amoxicillin fails in >20 % of cases. A rescue therapy with PPI-amoxicillin-levofloxacin still fails in >20 % of patients.
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The eradication rate for the concomitant therapy was much higher than those of the standard triple therapy or sequential therapy (ClinicalTrials.gov number NCT01922765).
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Departments of Gastroenterology and Histopathology, Evangelismos Hospital, Athens, Greece.
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The aim of this randomised study in split-mouth design, in which 24 patients from the recall programme of Marburg University Department of Periodontology were enrolled, was to compare topical application of a metronidazole 25% dental gel with subgingival scaling. The clinical parameters used were pocket probing depth (PPD) and bleeding on probing (BOP); these were recorded at baseline and 1, 3, 6, 14, 18 and 24 months after completion of treatment. In addition, plaque samples were taken from all mesial pockets for evaluation by dark-field microscopy. All patients had at least one tooth in each quadrant with a PPD of 5 mm or more showing BOP when they entered the study. The treatment consisted of 2 applications of dental gel in 2 randomly selected quadrants (on days 0 and 7) as well as subgingival scaling of the remaining quadrants. Statistical evaluation of all sites with a baseline PPD of 5 mm or more showed that both methods led to a significant reduction in PPD and BOP in the first 6 months. The average reduction in PPD was 1.3 mm in the gel group and 1.5 mm in the scaling group, with the tendency to bleeding being reduced by ca. 50% in both groups. After 24 months, improvements of 0.6 mm and 0.5 mm respectively were observed in PPD. The tendency to bleeding had undergone a slight increase but was still below baseline values. No statistically significant differences were observed between the two methods, although the results recorded with subgingival scaling were slightly better. Dark-field microscopy revealed a shift in the composition of the bacterial flora, suggesting a more physiological situation, which was maintained for 6 months before reverting consistently after 18 months to the baseline values of the plaque composition. Overall, application of a metronidazole 25% dental gel led in recall patients to an improvement in the investigated clinical and microbiological parameters comparable with subgingival scaling. After 24 months, the clinical parameters still displayed a very slight improvement over baseline values; after 18 months the microflora had reverted to its baseline composition.
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Antimicrobial resistance in Helicobacter pylori is a serious and increasing problem, and the development of rapid, reliable methods for detecting resistance would greatly improve the selection of antibiotics used to treat gastric infection with this organism. We assessed whether detection of the RdxA protein could provide the basis for determining the susceptibility of H. pylori to metronidazole. In order to raise polyclonal antisera to RdxA, we cloned the rdxA gene from H. pylori strain 26695 into the commercial expression vector pMAL-c2, purified the resultant fusion protein by affinity chromatography, and used this recombinant RdxA preparation to immunize rabbits. We then used this specific anti-RdxA antibody to perform immunoblotting on whole bacterial cell lysates of 17 metronidazole-sensitive and 27 metronidazole-resistant clinical isolates of H. pylori. While a 24-kDa immunoreactive band corresponding to the RdxA protein was observed in all metronidazole-sensitive strains, this band was absent in 25 of 27 resistant isolates. Our results indicate that testing for the absence of the RdxA protein would identify the majority of clinical isolates that will respond poorly to metronidazole-containing eradication regimens and have implications for the development of assays capable of detecting metronidazole resistance in H. pylori.
Eradication of H. pylori was achieved in 69 patients (84%, 95% CI: 75-90%) after the first treatment. Four patients (4/82 = 5%) were withdrawn from the study because of side-effects. All of the remaining nine patients had their H. pylori infection eradicated after the second treatment course (95% CI: 70-100%). Seventy-eight patients had a follow-up examination after a median 30 months of the initial eradication of H. pylori, and all but one remained free of infection and none had an ulcer relapse.
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The aim of this study was to evaluate the effect of calcium hydroxide (CH) and antibiotic pastes, including a mixture of metronidazole and ciprofloxacin, with and without minocycline or cefaclor, on the dislocation resistance of mineral trioxide aggregate (MTA) to root dentin.
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The widespread use of antibiotics for prophylaxis and treatment of bacterial infections has lead to the emergence of resistant human pathogens. Great differences have been documented between European countries in the use of systemic antibiotics. In parallel, significant differences in levels of resistant pathogens have been documented.
Acid pump inhibitors combined with antimicrobials cure gastritis and peptic ulcer disease but a standard therapy has not yet been established. We therefore investigated a triple therapy with pantoprazole.