Hi Yahia,

The American College of Gastroenterology (ACG), the Canadian

Helicobacter Study Group , and the Canadian Dyspepsia Working Grouprecommend proton pump inhibitor (PPI)-based triple therapy (standard PPI dose BID + clarithromycin 500 mg BID + amoxicillin 1000 mg BID [or metronidazole 500 mg BID if

penicillin allergic]) as first-line treatment of H.pylori infection.

No guideline recommend Monotherapy for H. pylori infection.

Resistance to such a regimen is on the rise. Due the resistance rate, clinicians are

seeking effective alternatives to the standard triple therapy regimen. Several alternative regimens (e.g., quadruple therapy, sequential therapy, four drug nonbismuth-based concomitant therapy, fluoroquinolone-based therapy, etc) have been tried for H. pylori treatment.

Regards

Hello Dr Yaser,

Thank you very much for your reply. The problem with triple therapy is its inconvenience to patients. The rise of yeast infection due to the usage of multiple antibiotics is another issue. Also the outcome of triple therapy is not that great as the rate of failure is increasing.

Regards

The only possibility to obtain a monotherapy is to built a pill containing three antibiotics. I think that a similar drug is available in Germany, but my information is poor. However, it is better to avoid to treat the bacterium than to use a regimen which provokes a sure failure and an antibiotic resistance.

I think that the reference reported is the only example of monotherapy in literature:

Lancet. 2011 Mar 12;377(9769):905-13. Helicobacter pylori eradication with a capsule containing bismuth subcitrate potassium, metronidazole, and tetracycline given with omeprazole versus clarithromycin-based triple therapy: a randomised, open-label, non-inferiority, phase 3 trial. Malfertheiner P, Bazzoli F, Delchier JC, Celiñski K, Giguère M, Rivière M, Mégraud F; Pylera Study Group.

The rise of yeast infection due to the use of multiple antibiotics may be prevented by the supplementation with probiotics. A meta-analysis showed that lactobacollus plantarum is very effective in preventing side effects of a multi-antibiotic therapy.

Thank you very much dear Lerardi Enzo for the replies. One patent claims that Artemisinin with a PPI can be very helpful as a bi-therapy against H.pylori with minimum side effect.

Other studies suggest taking mucolytics like NAC, Pronase, nittokinase, Ecabet Sodium. Ecabet Sodium interestingly increases the eradication rate when given with Amoxicillin. Ecabet sodium is already marketed in Japan as anti ulcer. Ecabet sodium was first isolated from resin of pine. Pine nut oil has been used in the ex URSS and China as an alternative remedy against gastritis, ulcers.

The effect of mucolytics in enhancing the antibiotic effects against H. pylori is well known and explained with the need of bacteriun of survive under gastric mucus layer where there is the ideal microaerophilic environment for the bacterium itself. Artemiinin is an anti-malarial drug whose anti-H. pylori action has been demonstrated only "in vitro". In my country it is available in association with a quinine compound, but this pill may be safely used only for three days for the nephrooxic and neurotoxic effects when the time of administration is prolonged. Some details about the patent you mention are a very useful tool.

H. pylori is susceptible in vitro to several antibiotics, but there are no drugs that are effective in vivo when delivered as a monotherapy. Because H. pylori infection is recalcitrant to monotherapy, standard guidelines for treatment consist of 7 to 14 days of therapy with three drugs. Recent success rates of this regimen have decreased to 75% in some areas of the world, which is due at least partly to increasing drug resistance. As a result, new treatments with activity against drug-resistant H. pylori are urgently needed.

Discovery of SQ109. SQ109 was discovered by screening a combinatorial library to identify new drugs for TB, and represents an entirely new class of antibacterial compounds with a novel mechanism of action. Interestingly, the in vitro bacterial mutation rate for SQ109 is very low, suggesting that development of resistance to the drug may be difficult to achieve. Later studies found that SQ109 also had activity against a limited set of additional bacteria and fungi.

SQ109 has very promising activity against H. pylori. SQ109 is active against all strains of H. pylori tested, with an MIC of 8-20 μM. It kills 99.99% of H. pylori within 4 hours at a concentration well below that maintained in stomach for this length of time after oral administration. In addition, SQ109 demonstrated superior efficacy compared to amoxicillin and metronidazole, suggesting that incorporation of SQ109 into the multidrug regimen could have significant benefits over standard-of-care.

Pharmacology. Stomach concentration of SQ109, based on animal studies conducted with radioactive drug, is estimated at >300 μg/mL at 4 hr, at least 15-fold higher than the SQ109 H. pylori MIC and >4 times the concentration of drug that kills H. pylori in 4 hr. In bactericidal time course studies, SQ109 demonstrated both thermal and pH stability, suggesting that it will be active in stomach tissues.