ABSTRACT
Introduction: Helicobacter pylori is the most common prevalent chronic human bacterial infection estimated in 50% of the global population but only induces clinical diseases in 10-20% of infected individuals. These include peptic ulcers, acute and atrophic gastritis, intestinal metaplasia, gastric adeno-carcinoma and gastric Bcell lymphoma. H. pylori infection has become highly resistant to traditional first-line treatment regimens because of antibiotic resistance coupled with poor patient compliance with completing the treatment course. Many clinical studies proved that nitazoxanide [NTZ] was found to be well tolerated by humans, with an encouraging rate of eradication when it was administered with omeprazole
Aims: The aim of the work is to compare between the efficacy of traditional triple therapy and nitazoxanidebased quadruple therapy in treatment of H. pylori and to evaluate the efficacy of nitazoxanide-based regimens as a rescue regimen for H. pylori eradication in resistant patients
Methodology: This study was carried out on 85 Helicobacter pylori [H. pylori] infected patients; Patients were classified in to 3 groups: Group 1: 60 patients with positive H. pylori Ag taking 14 days triple therapy composed of amoxicillin [1 gm twice daily], clarithromycin [500 mg twice daily] and omeprazole [40 mg once daily].; Group 2: 25 patients with positive H. pylori Ag [naïve: not having previously taken or received a particular treatment for H. pylori] taking 14 days quadruple therapy composed of nitazoxanide [500 mg twice daily], in addition to triple therapy.; Group 3: 22 patients with positive H. pylori Ag after treatment [resistant for triple therapy from group 1] taking 14 days nitazoxanide-based quadruple therapy
Results: This work recorded the best results for H. pylori eradication [92%] in group II who received nitazoxanide based quadruple therapy compared with group I eradication rate [63.3%], who received traditional triple therapy regimen and better results [77.3%] in group III [resistant patients from group I]
Conclusion: This study could state that, using nitazoxanide can overcome traditional triple therapy resistance; in addition to its efficacy in treating naïve patients who didn't take any medical treatment for H. pylori
Recommendations: Nitazoxanide [NTZ] based regimen namely NTZ/ clarithromycin / PPIs and amoxicillin is a recommended H. pylori therapeutic regimen in our community
ABSTRACT
Spontaneous bacterial peritonitis [SBP] is a frequent and severe complication in cirrhotic patients with ascites that usually results in renal failure and death despite the efficacy of the current antibiotic therapy. The aim of this study was determine serum and ascitic fluid of soluble-L selectin [s-L Selectin], intracellular adhesion molecule-1 [ICAM-1], Vascular cell adhesion molecule-1 [VCAM-1] and vascular endothelial growth factor [VEGF] in cirrhotic patients, and to search for a relationship between them and SBP. This study was performed on 30 cirrhotic patients with SBP. Their ages ranged [from 38-55 years] with mean of [32 +/- 5.5], 30 cirrhotic patients with non-infected ascites; their ages ranged [from 30-52 years] with mean of [35 +/- 6.5]. This group considered as cirrhotic control group and 20 healthy control subjects their ages ranged [from 28-55 years] with mean of [30 +/- 7.5]. Serum and ascitic fluid of adhesion molecules as well as VEGF levels were significantly higher in cirrhotic patients with SBP as well as cirrhotic patients with non-infected ascites as compared to healthy control group. There were significant increase in serum and ascitic fluid level of leukocyte, PMN and ICAM-1 in SBP as compared to cirrhotic with non-infected ascites. There was non-significant decrease in serum and AF level of VEGF in cirrhotic control group as compared to SBP group. The ascitic fluid PMN and s-L Selectin were higher in culture positive SBP patients particularly in those with gram positive isolates, where these are non-significant increase in serum and ascitic fluid level of VEGF in culture positive SBP than culture negative cases. Positive correlation was found between serum and ascitic fluid level of ICAM-1 in SBP and non-infected cirrhotic group. Also, positive correlation was found between VEGF levels in serum ascetic fluid levels in both cirrhotic groups [SBP and non-infected cirrhotic group]. These data suggest that: Significant elevated level of VEGF in both SBP and non infected cirrhotic patient may have pathophsiological consequences of local regulation of vascular tone and endothelial permeability, significant elevated level of adhesion molecules in both SBP and non-infected cirrhotic patients are due to inflammatory response and endothelial cell activation. Serum and ascetic fluid of ICAM-1 can be used as useful marker for diagnosis of SBP and for monitoring the treatment of cirrhotic patients