Empirical Second-Line Therapy in 5000 Patients of the European Registry on Helicobacter pylori Management (Hp-EuReg).

BACKGROUND & AIMS: After a first Helicobacter pylori eradication attempt, approximately 20% of patients will remain infected. The aim of the current study was to assess the effectiveness and safety of second-line empiric treatment in Europe. METHODS: This international, multicenter, prospective, non-interventional registry aimed to evaluate the decisions and outcomes of H pylori management by European gastroenterologists. All infected adult cases with a previous eradication treatment attempt were registered with the Spanish Association of Gastroenterology-Research Electronic Data Capture until February 2021. Patients allergic to penicillin and those who received susceptibility-guided therapy were excluded. Data monitoring was performed to ensure data quality. RESULTS: Overall, 5055 patients received empiric second-line treatment. Triple therapy with amoxicillin and levofloxacin was prescribed most commonly (33%). The overall effectiveness was 82% by modified intention-to-treat analysis and 83% in the per-protocol population. After failure of first-line clarithromycin-containing treatment, optimal eradication (>90%) was obtained with moxifloxacin-containing triple therapy or levofloxacin-containing quadruple therapy (with bismuth). In patients receiving triple therapy containing levofloxacin or moxifloxacin, and levofloxacin-bismuth quadruple treatment, cure rates were optimized with 14-day regimens using high doses of proton pump inhibitors. However, 3-in-1 single capsule or levofloxacin-bismuth quadruple therapy produced reliable eradication rates regardless of proton pump inhibitor dose, duration of therapy, or previous first-line treatment. The overall incidence of adverse events was 28%, and most (85%) were mild. Three patients developed serious adverse events (0.3%) requiring hospitalization. CONCLUSIONS: Empiric second-line regimens including 14-day quinolone triple therapies, 14-day levofloxacin-bismuth quadruple therapy, 14-day tetracycline-bismuth classic quadruple therapy, and 10-day bismuth quadruple therapy (as a single capsule) provided optimal effectiveness. However, many other second-line treatments evaluated reported low eradication rates. ClincialTrials.gov number: NCT02328131.

Delafloxacin against Helicobacter pylori, a potential option for improving eradication success?

Increase in Helicobacter pylori resistance to fluoroquinolones has been reported in many countries. The aim of the study was to compare, for the first time to our knowledge, levofloxacin and delafloxacin activities against H. pylori, including numerous levofloxacin- and multidrug resistant strains. Minimal inhibitory concentrations (MICs) of six antibiotics against 71 consecutive clinical strains were determined. Delafloxacin MIC50 and MIC90 were 0.016 and 0.125 µg/mL versus 0.125 and ≥32 µg/mL, respectively, for levofloxacin. Against the 19 levofloxacin resistant strains, delafloxacin MICs50 and MICs90 were 0.094 and 0.38 µg/mL, respectively. Delafloxacin MICs against the 21 strains with double or multidrug resistance were ≤0.75 µg/mL. The low MICs, the activity against levofloxacin resistant and multidrug resistant H. pylori strains and the increased activity of the agent in acidic conditions make delafloxacin worthy of further investigation, aiming at optimizing fluoroquinolone-based eradication regimens.

Clonal dissemination of multilocus sequence type ST15 KPC-2-producing Klebsiella pneumoniae in Bulgaria.

A total of 36 consecutive clinical and two fecal-screening carbapenem-resistant Klebsiella pneumoniae isolates from two Bulgarian university hospitals (Varna and Pleven) were investigated. Susceptibility testing, conjugation experiments, and plasmid replicon typing were carried out. Beta-lactamases were characterized by isoelectric focusing, PCR, and sequencing. Clonal relatedness was investigated by RAPD and multilocus sequence typing (MLST). Most of the isolates demonstrated multidrug resistance profile. Amikacin and tigecycline retained good activity with susceptibility rates of 95 and 87%, respectively. The resistance rate to colistin was 63%. Six RAPD- and MLST-types were identified: the dominating MLST-type was ST15 (27 isolates), followed by ST76 (six isolates), and ST1350 (two isolates). ST101, ST258, and ST151 were detected once. All except one of the K. pneumoniae produced KPC-2, mostly in combination with CTX-M-15, while for one isolate (ST101) the enzymes OXA-48 and CTX-M-14 were found. All KPC-2-producing transconjugants revealed the presence of IncFII plasmid. The OXA-48- and CTX-M-14-producing isolate showed the presence of L/M replicon type. The dissemination of KPC-2-producing K.pneumoniae in Bulgaria is mainly due to the sustained spread of successful ST15 clone and to a lesser extent of ST76 clone. This is the first report of OXA-48 producing ST101 K. pneumoniae in Bulgaria.

Honey and green/black tea consumption may reduce the risk of Helicobacter pylori infection.

The aim of the study was to evaluate the influence of dietary and demographic factors and some habits on the prevalence of Helicobacter pylori infection in 150 dyspeptic patients examined endoscopically and by the urea breath test. Positivity rate was lower (50.6%) in patients consuming honey ≥1 day weekly compared with the remainder (70.8%) and in those consuming green/black tea ≥1 day weekly (45.2%) compared with the other patients (64.8%). Logistic regression confirmed that the factors associated with significantly lower H. pylori positivity rate were the consumption of honey (odds ratio [OR], 0.38; 95% confidence interval [CI], 0.19-0.78) and green/black tea (OR, 0.45; 95% CI, 0.21-0.95). In conclusion, honey and green/black tea intake is associated with reduced prevalence of H. pylori infection.

Comparative evaluation of the activity of plant infusions against Helicobacter pylori strains by three methods.

The aim of the study was to assess the activities of six plant infusions against Helicobacter pylori strains using a comparative screening assay (CSA), agar-well diffusion method (AWDM) and microscopy. Green tea, St John's wort (SJW), rooibos, peppermint, chamomile and lime flower aqueous infusion concentrations were chosen to mimic those in herbal teas/tisanes. CSA concentrations were 4.5 mg ml⁻¹ for chamomile and 6.8 mg ml⁻¹ for the other agents. AWDM amounts were 0.4 mg/well for the chamomile and 0.6 mg/well for the other agents. Using CSA, ≥8 × 104 colony forming unit reduction was found in >60 % of the strains by the green tea (81.5 %), SJW (75.9 %) and rooibos (63.0 %) within 2 h. Similarly, by AWDM, the activity against >60 % of the strains was found by the green tea, SJW and rooibos. Gram staining results were alike, showing mostly/only coccoids in >66 % of the strains by the same three agents within 2 h. Lime flowers showed the lowest activity by all methods. In conclusion, CSA allows comparing the activities of many agents against numerous strains. To our knowledge, these are the first data about rooibos and lime flower activities against H. pylori. All the three methods revealed that the most active agents were the green tea, SJW and rooibos, which also possess additional beneficial properties, e.g. antioxidant, anti-inflammatory and antitumor effects, therefore these plants may have a beneficial use as prophylactic agents against or adjuvants in the therapy of H. pylori infection.