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What should I avoid while giving amoxicillin to my pet? There are no restrictions on food or activity during treatment with amoxicillin unless otherwise directed by your veterinarian. Before giving amoxicillin, tell your veterinarian if your pet is being given another antibiotic (for the same or a different infection), allopurinol, or probenecid. You may not be able to give amoxicillin or you may need to have the dosage adjusted. Drugs other than those listed here may also interact with amoxicillin. Talk to your veterinarian or pharmacist before giving any prescription or over-the-counter medicines, including vitamins, minerals, and herbal products.

Amoxicillin Directions: Amoxicillin is a broad-spectrum penicillin antibiotic available by prescription used to treat various infections caused by susceptible strains of bacteria. Amoxicillin can be used to treat infections such as ear infections, urinary tract infections, and skin infections.

Amoxicillin may also be used for purposes other than those listed. Amoxicillin is available in tablet form in 100 mg and 400 mg strengths, and in capsule form in 250 mg and 500 mg strengths. Contact your veterinarian immediately if your pet develops severe or bloody diarrhea.

Give all of the amoxicillin that is prescribed for your pet. Symptoms may begin to improve before the infection is completely treated.

Amoxicillin Dosage: Amoxicillin Dosage for Cats Weight Dosage All weights

Give

Your veterinarian will determine the actual dose based on the type of infection being treated.

Amoxicillin Dosage for Dogs Weight Dosage All weights Give 5-10 mg/lb of pet's body weight every 12-24 hours.

Your veterinarian will determine the actual dose based on the type of infection being treated.

Storage: Store tablets and capsules at room temperature. Objective To date, no randomised trials have compared the efficacy of vonoprazan and amoxicillin dual therapy with other standard

regimens

This study aimed to investigate the efficacy of the 7-day vonoprazan and low-dose amoxicillin dual therapy as a first-line H.

pylori treatment, and compared this with vonoprazan-based triple therapy. Design This prospective, randomised clinical trial was performed at seven Japanese institutions. pylori –positive culture test and naive to treatment were randomly assigned in a 1:1 ratio to either VA-dual therapy (vonoprazan 20 mg+amoxicillin 750 mg twice/day) or VAC-triple therapy (vonoprazan 20 mg+amoxicillin 750 mg+clarithromycin 200 mg twice/day) for 7 days, with stratification by age, sex, H.

Eradication success was evaluated by 13 C-urea breath test at least 4 weeks after treatment. Results Between October 2018 and June 2019, 629 subjects were screened and 335 were randomised. The eradication rates of VA-dual and VAC-triple therapies were 84.5% and 89.2% (p=0.203) by intention-to-treat analysis, respectively, and 87.1% and 90.2% (p=0.372) by per-protocol analysis, respectively. VA-dual was non-inferior to VAC-triple in the

per-protocol

The eradication rates in strains resistant to clarithromycin for VA-dual were significantly higher than those for VAC-triple (92.3% vs 76.2%; p=0.048).

The incidence of adverse events was equal between groups.

Conclusion The 7-day vonoprazan and low-dose amoxicillin dual therapy provided acceptable H. pylori eradication rates and a similar effect to vonoprazan-based triple therapy in regions with high clarithromycin resistance.

helicobacter pylori - treatment antibiotics - clinical trials gastric inflammation clinical trials.

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helicobacter pylori - treatment antibiotics - clinical trials gastric inflammation clinical trials. Macrolides, including clarithromycin, readily induce changes in the resistome of Helicobacter pylori, and the clarithromycin resistance of H.

Usage of clarithromycin should be discontinued as an empirical treatment in wide-scale strategies for H. Vonoprazan strongly inhibits gastric acid secretion, and vonoprazan-based triple therapy (VAC-triple) achieves sufficient eradication rates and high safety.

Vonoprazan and low-dose amoxicillin dual therapy for 7 days (VA-dual) is a regimen with minimal usage of antibiotics and is simpler than current H.

VA-dual achieved acceptable eradication rates of 85% in intention-to-treat and 87% in per-protocol analyses.

VA-dual achieved an eradication rate of over 85% for both clarithromycin-susceptible and clarithromycin-resistant strains, and achieved a higher eradication rate than VAC-triple against clarithromycin-resistant strains.

How might it impact on clinical practice in the foreseeable future? In the era of growing antimicrobial resistance, VA-dual is a potential new first-line H. pylori therapy for cases of high clarithromycin resistance because it provides an acceptable eradication rate and high safety, and will have a potentially less negative impact on future antimicrobial resistance of H.

Helicobacter pylori infection is common chronic bacterial infections in humans, affecting approximately 50% of the global population.1 Although the prevalence of H.

pylori is generally declining, the prevalence of the infection and the reinfection rates remain high in several regions.2 As H. pylori infection causes gastritis, peptic ulcer disease, mucosal-associated lymphoid tissue and gastric cancer, H.

pylori eradication treatment is performed worldwide to improve and reduce these conditions.3–5. pylori treatment has decreased owing to increasing its antimicrobial resistance.

Recent international guidelines recommend four-drug combination therapies containing 2–3 kinds of antibiotics for 10–14 days as the first-line treatment for H.

pylori in regions with high clarithromycin (CLA) resistance to overcome its antimicrobial resistance.6–8 However, these quadruple regimens have several disadvantages, including severe side effects, high cost and low compliance due to the use of multiple antibiotic agents for a long period; these features have hampered its implementation in routine clinical practice.

Furthermore, the use of multiple antibiotic agents in H.

pylori treatment can increase the risk of future antimicrobial resistance. Thus, novel regimens and approaches enabling minimal antibiotic usage and shorter treatment duration are required to prevent antimicrobial resistance while achieving sufficient eradication rates.

Dual therapy composed of a proton-pump inhibitor (PPI) and amoxicillin (AMO) is the simplest regimen for H. pylori treatment and, because it is a single antibiotic therapy, we expect it will not contribute to the development of H.

Maintaining a near-neutral pH in the stomach during eradication therapy is important to succeed dual therapy regimen. Vonoprazan, a novel potassium-competitive acid blocker, provides a stronger and longer-lasting effect on the gastric acid suppression than other PPIs.9 Therefore, vonoprazan is expected to be more effective than other PPIs when used in dual therapy with AMO for the H.

pylori eradication has not been studied yet and no randomised studies have assessed the efficacy of dual therapy consisting of vonoprazan and AMO for H. The aim of this proof of concept study was to evaluate the efficacy and tolerability of the 7-day vonoprazan and low-dose AMO dual therapy (VA-dual) and to compare it with a 7-day vonoprazan, AMO and CLA triple therapy (VAC-triple) as the first-line treatments for H. This study was designed as a multicentre, open-label, randomised controlled trial. This study was conducted in accordance with the Declaration of Helsinki and the guidelines of the Consolidated Standards of Reporting Trials (CONSORT).

This study was registered with the University Hospital Medical Information Network (UMIN) Clinical Trials Registry (www.umin.ac.jp/ctr/) on 14 September 2018. Consecutive patients who underwent oesophagogastroduodenoscopy to evaluate the cause of any abdominal symptom or screening for upper GI cancer were recruited in seven institutions in Japan between October 2018 and June 2019. All the 629 recruited patients were screened and underwent H. pylori culture test through biopsy of the gastric mucosa. Patients were eligible if they were aged 20–79 years and had confirmed H. Patients were excluded if they had any of the following: history of receiving H. pylori eradication therapy; allergy to any of the study drugs; history of gastric surgery; use of PPIs, antibiotics or steroids that could not have been discontinued during this study; pregnancy or breast feeding; lack of informed consent.

pylori strains and antimicrobial susceptibility test.

At least two biopsies were collected from the gastric antrum and corpus to isolate H.

Biopsy specimens were used to inoculate Helicobacter selective agar medium (Nissui Pharmaceuticals, Tokyo, Japan) containing 10% laked horse blood and incubated under microaerophilic condition (85% N 2 , 10% CO 2 , 5% O 2 ) at 37? for 7–10 days.

The culture was considered positive if one or more colonies showed Gram negativity, urease, oxidase, catalase, and spiral or curved rods in morphology. pylori isolates was determined by the microbroth dilution method using Eiken Chemical dry plates (Eiken Chemical, Tokyo, Japan).

Each well of a 96-well microplate was coated with twofold serial dilutions of AMO and CLA and air-dried.

A saline suspension of the test strain was added to each well, and the cultures were incubated at 35? for 3 days in a microaerophilic atmosphere (O 2 , 10%; CO 2 , 5%).

The minimal inhibitory concentration (MIC) was defined as the lowest concentration of a test antibiotic that completely inhibited visible bacterial growth. MIC values of ?0.12 µg/mL for AMO and ?1 µg/mL for CLA were defined as resistance break points.

The 335 eligible patients were randomly assigned to receive either VA-dual or VAC-triple in a 1:1 allocation ratio. VA-dual consisted of 20 mg vonoprazan (Takeda Pharmaceutical, Tokyo, Japan) twice daily and 750 mg AMO twice daily for 7 days.

The VAC-triple consisted of 20 mg vonoprazan twice daily, 750 mg AMO twice daily and 200 mg CLA twice daily for 7 days.

AMO and CLA used in both therapies were from Takeda Pharmaceutical or of generic branding. The treatment group was randomly assigned by the UMIN Medical Research Support INDICE Cloud System. Randomisation was performed by dynamic balancing using the minimisation method, with stratification by age ( 13 C-urea breath test (UBT) (UBIT tablet; Otsuka Pharmaceutical, Tokyo, Japan) with success defined as a result of 80% (6 days) of drug compliance and underwent UBT.

Drug compliance was recorded in a specific questionnaire form by patients.

The secondary endpoints were the frequency and severity of adverse events and the comparison of the eradication rates between VA-dual and VAC-triple according to CLA susceptibility or MIC values of AMO.

The adverse events induced by the study drugs were documented in a specific questionnaire form filled in by patients for 14 days from the start of the therapy. When patients reported any adverse event in the questionnaire form, the investigators inquired them and assessed the severity using the 1 to 4 grading system based on the Common Terminology Criteria for Adverse Events (CTCAE) V.5.0.10 The outcomes in this study were not changed after the trial commenced.

In previous studies, the eradication rates were between 94%11 and 91%12 in similar regimens for first-line H.

pylori eradication rates of 90% in both VA-dual and VAC-triple groups and used non-inferiority design in this study; statistically, a non-inferiority margin of ?10% was the recommended level in a non-inferiority anti-infective trial13 and in H.

pylori treatment trials,14–16 although a non-inferiority margin of ?10%, compared with the 90% of estimated eradication rate of VAC-triple, may be clinically insufficient.

Assuming a power of 80% and an alpha of 0.025 (one-sided), at least 284 patients (142 patients in each group) would be required in the non-inferiority trial.

Assuming a follow-up loss of 10%, a sample size of 320 patients (160 patients in each group) was planned. Comparative non-inferiority of the two groups was assessed through the derivation of a two-sided 95% CI and hypothesis testing (one-sided ?-test). Differences between groups were analysed using Pearson’s ? 2 test and Student’s t-test for categorical and continuous variables, respectively. All p values were two-sided, except for the test of non-inferiority, and were considered statistically significant if p value View this table: View inline View popup. Baseline characteristics and prevalence of antimicrobial resistance of study patients. Download figure Open in new tab Download powerpoint. ITT, intention-to-treat; PP, per protocol; VA-dual, vonoprazan and amoxicillin dual therapy; VAC-triple, vonoprazan, amoxicillin and clarithromycin triple therapy. pylori eradication rates for each therapy are shown in table 2. pylori eradication rate

was

the

However, in the ITT analysis, it was less than the non-inferiority margin, and the VA-dual group did not reach statistically significant noninferiority compared with the VAC-triple group. Eradication rates according to antimicrobial susceptibility of H. Download figure Open in new tab Download powerpoint. Eradication rates of each therapy groups in the presence of clarithromycin resistance in PP population. CLA, clarithromycin; PP, per protocol; VA-dual, vonoprazan and amoxicillin dual therapy; VAC-triple, vonoprazan, amoxicillin and clarithromycin triple therapy. Download figure Open in new tab Download powerpoint. Eradication rates of each therapy groups according to MIC value of amoxicillin in PP population.

AMO, amoxicillin; MIC, minimal inhibitory concentration; PP, per protocol; VA-dual, vonoprazan and amoxicillin dual therapy; VAC-triple, vonoprazan, amoxicillin and clarithromycin triple therapy.