Comparison of efficacy and safety of levofloxacin-containing versus standard sequential therapy in eradication of Helicobacter pylori infection in Korea

Lee, Hyuk; Hong, Sung Noh; Min, Byung Hoon; Lee, Jun Haeng; Rhee, Poong–Lyul; Lee, Yong Chan; Kim, Jae J.

doi:10.1016/j.dld.2014.10.014

Cited by 16 publications

(12 citation statements)

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“…Previous studies on the quinolone resistance rate of H. pylori in Korea reported an increase and a corresponding shift to a higher value on the MIC histogram . The H. pylori eradication rates with quinolone‐containing regimens in Korea have been disappointing in terms of first‐line or third‐line therapies . Quinolone usage based on Korean insurance data was increased from 2007 to 2014, but these antibiotics seem now to be inappropriate as a first‐line H. pylori eradication regimen.…”

Section: Discussionmentioning

confidence: 99%

“…10,18,22,24 The H. pylori eradication rates with quinolone-containing regimens in Korea have been disappointing in terms of first-line or third-line therapies. [27][28][29] Quinolone usage based on Korean insurance data was increased from 2007 to 2014, 30 Although our current study had a nationwide multicenter design and is the largest such study to date in Korea, it had several notable limitations. First, our analysis was cross sectional and we could not check for any changing patterns of H. pylori antibiotic resistance.…”

Section: Ta B L E 3 Multidrug-resistance Profile Of Helicobacter Pylorimentioning

confidence: 99%

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Nationwide antibiotic resistance mapping of Helicobacter pylori in Korea: A prospective multicenter study

et al. 2019

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Introduction The eradication rates for Helicobacter pylori have decreased in Korea although the prevalence of this bacterium has also decreased. Antibiotic resistance is likely to be a crucial factor in H. pylori eradication success, and we therefore mapped these resistance patterns nationwide in Korea. Materials and Methods Five hundred and ninety adult subjects were prospectively enrolled from 2017 to 2018 from 15 centers across six geographic areas of Korea. A total of 580 biopsy tissues had been sampled from these patients during an upper endoscopy and were frozen at −80°C and delivered to a central laboratory. The agar dilution method was used to determine the minimum inhibitory concentration of amoxicillin, clarithromycin, metronidazole, tetracycline, ciprofloxacin, and levofloxacin for each H. pylori isolate. Results The culture success rate was 60.2% (349/580). Resistance rates against clarithromycin, metronidazole, amoxicillin, tetracycline, levofloxacin, and ciprofloxacin were 17.8%, 29.5%, 9.5%, 0%, 37.0%, and 37.0%, respectively. The geographic distribution of metronidazole and quinolone resistance was highly variable. Some subjects had multiple H. pylori strains in the antrum and body of the stomach and showed a heterogeneous resistance profile between these anatomic areas. The H. pylori multidrug resistance (MDR) rate was 25.2% (88/349) among amoxicillin, clarithromycin, metronidazole, tetracycline, and quinolone and 11.2% (39/349) among four of these major antibiotics except for quinolone. The Seoul and Chungcheong areas showed a relatively lower MDR rate. Conclusion The antibiotic resistance of H. pylori differs by drug and geographic area in Korea. Detailed nationwide antibiotic resistance mapping is needed to develop an effective H. pylori eradication strategy.

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Section: Discussionmentioning

confidence: 99%

Section: Ta B L E 3 Multidrug-resistance Profile Of Helicobacter Pylorimentioning

confidence: 99%

Nationwide antibiotic resistance mapping of Helicobacter pylori in Korea: A prospective multicenter study

et al. 2019

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“…Levofloxacin can also be used as part of a sequential regimen. In this context, a Korean study found no difference between eradication rates (ITT) for levofloxacin‐based sequential therapy (78%) versus sequential therapy (79%) .…”

Section: Fluoroquinolonesmentioning

confidence: 98%

Treatment of Helicobacter pylori Infection 2015

et al. 2015

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Many interesting articles have been published from many parts of the world over the last year assessing different issues around Helicobacter pylori eradication therapy. This article will address the published literature over the last year pertaining to the topic of treatment of H. pylori infection. The main themes that emerge are assessing the efficacy of standard triple therapy, as well as exploring new first-line treatments, mainly optimized nonbismuthand bismuth-containing quadruple therapies with some promising data also emerging on dual therapy. There was also considerable progress in investigating antibiotic resistance rates with much more data emerging from varied parts of the world compared to recent years. There have also been advances in the use of adjunctive therapies, especially probiotic therapies. Undoubtedly, the eradication of H. pylori remains a worthwhile goal to alleviate the burden of diseases caused by the complications of this infection, including dyspepsia, peptic ulcer disease, and gastric cancer. Triple TherapyA number of studies have been published this year, primarily from Asia, on standard triple therapy which remains the regimen recommended in the majority of published guidelines. A meta-analysis from China showed suboptimal eradication rates in this part of the world with a pooled rate of 74.5% which was inferior when compared to sequential therapy with relative risk (RR) = 0.863 [1]. Better, but still insufficient, eradication rates however were noted in Korea, with an overall eradication rate of 84% from 2005 to 2010 [2]. In Japan, while rates remain clearly suboptimal, eradication rates by per-protocol (PP) analysis have not changed between 2001 and 2010 although there has been a decline in eradication rates by intention-to-treat (ITT) analysis [3]. Another Japanese group from a region of higher clarithromycin resistance compared 7-day standard triple therapy with rabeprazole, amoxicillin, and clarithromycin (RAC) to rabeprazole, amoxicillin, and metronidazole (RAM). They found ITT eradication rates of 73% in the RAC group and 91% in the RAM group [4]. In other regions, a study in Nigeria found an eradication rate of 87% for triple therapy with no difference between 7 and 10 days of treatment [5]. An interesting study from Spain showed that when clarithromycin susceptibility testing is carried out prior to treatment, eradication rates reach 94% compared to 72% for empiric treatment, based on a 10-day regimen [6]. Similar findings emerged from a Japanese study where 97% eradication was achieved when antimicrobial susceptibility testing was carried out prior to treatment, and it was 95% eradication in a Korean study [7,8]. Another study from Spain examined the optimal first-line eradication regimen for patients with penicillin allergy and reported ITT eradication rates with omeprazole-clarithromycin-metronidazole of only 57% compared to 74% for PPI-bismuth-tetracyclinemetronidazole, with equivalent rates of compliance and adverse events. In this specific group for second-line treat...

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“…However, those previous studies have enrolled either too small number of patients or patients with various indications including nonulcer dyspepsia. One the other hand, a recent Korean study reported near 80% of efficacy of levofloxacin-based sequential regimen as first-line treatment 16. Therefore, this study was designed to evaluate the efficacy and usefulness of levofloxacin-based third-line rescue therapy for H. pylori eradication in peptic ulcer disease.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of Levofloxacin-Based Third-Line Therapy for the Eradication of Helicobacter pylori in Peptic Ulcer Disease

et al. 2017

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Background/AimsThe resistance rate of Helicobacter pylori is gradually increasing. We aimed to evaluate the efficacy of levofloxacin-based third-line H. pylori eradication in peptic ulcer disease.MethodsBetween 2002 and 2014, 110 patients in 14 medical centers received levofloxacin-based third-line H. pylori eradication therapy for peptic ulcer disease. Of these, 88 were included in the study; 21 were excluded because of lack of follow-up and one was excluded for poor compliance. Their eradication rates, treatment regimens and durations, and types of peptic ulcers were analyzed.ResultsThe overall eradiation rate was 71.6%. The adherence rate was 80.0%. All except one received a proton-pump inhibitor, amoxicillin, and levofloxacin. One received a proton-pump inhibitor, amoxicillin, levofloxacin, and clarithromycin, and the eradication was successful. Thirty-one were administered the therapy for 7 days, 25 for 10 days, and 32 for 14 days. No significant differences were observed in the eradication rates between the three groups (7-days, 80.6% vs 10-days, 64.0% vs 14-days, 68.8%, p=0.353). Additionally, no differences were found in the eradiation rates according to the type of peptic ulcer (gastric ulcer, 73.2% vs duodenal/gastroduodenal ulcer, 68.8%, p=0.655).ConclusionsLevofloxacin-based third-line H. pylori eradication showed efficacy similar to that of previously reported first/second-line therapies.

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Comparison of efficacy and safety of levofloxacin-containing versus standard sequential therapy in eradication of Helicobacter pylori infection in Korea

Cited by 16 publications

References 46 publications

Nationwide antibiotic resistance mapping of Helicobacter pylori in Korea: A prospective multicenter study

Nationwide antibiotic resistance mapping of Helicobacter pylori in Korea: A prospective multicenter study

Treatment of Helicobacter pylori Infection 2015

Efficacy of Levofloxacin-Based Third-Line Therapy for the Eradication of Helicobacter pylori in Peptic Ulcer Disease

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