Antimicrobial resistance of H. pylori to the outcome of 10-days vs. 7-days Moxifloxacin based therapy for the eradication: a randomized controlled trial

Abstract

IntroductionAntibiotic resistance decreases success of Helicobacter pylori (Hp) eradication. Recently published results show low rate of resistance and better compliance with moxifloxacin based regiments.Aims&methodsWhether 7 days moxifloxacin with lansoprasole and amoxycillin can be compared with 10 days moxifloxacin with lansoprasole and amoxycillin according to moxifloxacin resistance. Patients with non-ulcer dyspepsia who had culture and histology positive Hp infection (n = 150) were randomly assigned into two groups. The first group (n = 75) received moxifloxacin 400 mg/d during 7 days and the other (n = 75) received moxifloxacin 400 mg/d during 10 days. All patients received amoxycillin 1 g twice daily, lansoprasole 30 mg twice daily. All Hp cultures were tested for sensitivity to moxifloxacin.Results138 patients (92%) completed the study, 68 in the first group and 70 in the second. Eradication rates were 84% (57/68) and 76% (57/75) in the 7 days moxifloxacin group and 90% and 84% in the second group (63/70, 63/75) according to the PP and ITT analysis; p = n.s. Among 129 patients (86% of study group), 6% of strains were primary resistant to moxifloxacin.Eradication of moxifloxacin sensitive/resistant strains was 98%/66%, p < 0.05ConclusionAccording to our results we recommend 7 days moxiflixacin based triple therapy.

Two-week, high-dose proton pump inhibitor, moxifloxacin triple Helicobacter pylori therapy after failure of standard triple or non-bismuth quadruple treatments

“…14 day) levofloxacin treatment might, perhaps, achieve a similarly high H. pylori cure rate than that obtained with moxifloxacin in the present study, although head to head (moxifloxacin vs. levofloxacin) studies would be necessary to confirm this hypothesis. Specifically with moxifloxacin, two recent studies have demonstrated that a triple therapy with this quinolone for 10 days is more effective than the same treatment for 5 or 7 days [24,28]. In another study, increasing the duration of therapy was expected to increase the eradication rate, but the expected increased did not materialize, most likely because of coincident marked increase in the prevalence of resistance to moxifloxacin [32].…”

“…Initially, the combination of a PPI, amoxicillin, and moxifloxacin as the first-line regimen was associated with favourable results [23][24][25][26][27][28][29]. Later on, other authors studied this same regimen in patients with one previous eradication failure (standard triple therapy) and reported variable results [30][31][32][33][34], with eradication rates ranging from 67% to 76%.…”

“…Additionally, the impact of antibiotic resistance to moxifloxacin in the rescue therapy could not be evaluated by this study. It has been established that primary resistance of H. pylori to moxifloxacin significantly reduces the eradication rate [23,24]. However, in vitro antimicrobial susceptibility to quinolones in general and to moxifloxacin in particular does not necessarily lead to eradication in vivo (and vice versa) [40].…”

Treatment prospects of Helicobacter pylori infection

“…w badaniu z randomizacją poddali 150 pacjentów alternatywnej terapii z użyciem moksyfloksacyny [13]. Jedna grupa chorych otrzymywała moksyfloksacynę w dawce 400 mg raz na dobę oraz AMX i lanzoprazol w dawkach standardowych przez 7 dni, natomiast druga przyjmowała te same leki przez 10 dni.…”

Helicobacter pylori: Infektion mit lokalen Komplikationen und systemischen Auswirkungen

“…Eine kürzliche veröffentliche Studie demonstrierte Eradikationsraten von 92% für die Moxifloxacin-basierte Therapie gegenüber 79% mit der Clarithromycin-basierten Triple-Therapie[44]. Generell sollte die Therapie mit Moxifloxacin für 10 Tage durchgeführt werden und eine Dosierung von 800 mg/d sollte der 400-mg-Standarddosis vorgezogen werden[7]. Die Moxifloxacin-basierte Triple-Therapie kann als sichere und effiziente Zweitlinientherapie angewendet werden.In den letzten Jahren wurde der Zusammenhang zwischen H. pylori und extragastralen Erkrankungen immer weiter untersucht, und es wurden Hypothesen aufgestellt, dass H. pylori bei einigen Krankheiten von Nutzen sein kann.…”