Comparison of Levofloxacin- and Moxifloxacin-Based Triple Therapies with Standard Treatment in Eradication of Helicobacter Pylori as First-Line Therapy

Rakici, Halil; Ayaz, Teslime; Akdoğan, Remzi Adnan; Bedir, Recep

doi:10.1159/000369788

Cited by 14 publications

(12 citation statements)

References 21 publications

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“…According to a multiregion prospective 7-year study by Liu et al[ 46 ], the prevalence of H. pylori after moxifloxacin treatment was 17.2%. Resistance to moxifloxacin was reported to be similar to that of levofloxacin, ranging from 14.9% to 20.0% in Turkey[ 29 ]. The increasing antibiotic resistance rate makes the eradication of H. pylori more difficult.…”

Section: Discussionmentioning

confidence: 99%

Fourth-generation quinolones in the treatment of Helicobacter pylori infection: A meta-analysis

An¹,

Wang²,

Wu³

et al. 2018

WJG

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AIMTo assess the efficacy and safety of fourth-generation quinolones for Helicobacter pylori (H. pylori) eradication, we conducted this systematic review and meta-analysis of randomized clinical trials.METHODSMajor literature databases (PubMed, EMBASE and the Cochrane Central Register of Controlled Trials) were searched for relevant articles published prior to February 2018. We performed a meta-analysis of all randomized clinical trials that examined the efficacy of H. pylori eradication therapies and included fourth-generation quinolones in the experimental arm. Subgroup analyses by regions and different types of fourth-generation quinolones were also performed.RESULTSTen studies including a total of 2198 patients were assessed. A meta-analysis of randomized controlled trials showed that the eradication rate of therapies containing non-fourth-generation quinolones was significantly lower than that of therapies containing fourth-generation quinolones by intention-to-treat (ITT) analysis [75.4% vs 81.8%; odds ratio (OR) = 0.661; 95% confidence interval (CI): 0.447-0.977; P = 0.038]. This analysis also showed that the eradication rate of the therapies containing non-fourth-generation quinolones was inferior to that of therapies containing fourth-generation quinolones by per-protocol analysis (79.1% vs 84.7%; OR = 0.663; 95%CI: 0.433-1.016; P = 0.059). Moreover, the occurrence of side effects was significantly different between the control and experimental groups by ITT analysis (30.6% vs 19.5%; OR = 1.874; 95%CI: 1.120-3.137; P = 0.017). The sub-analyses also showed significant differences in moxifloxacin therapies vs other fourth-generation quinolone therapies (84.3% vs 71.9%) and in Asian vs European groups (76.7% vs 89.1%).CONCLUSIONTherapies containing fourth-generation quinolones achieved a poor eradication rate in the treatment of H. pylori infection. Such regimens might be useful as a rescue treatment based on antimicrobial susceptibility testing. Different antibiotics should be chosen in different regions.

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Section: Discussionmentioning

confidence: 99%

Fourth-generation quinolones in the treatment of Helicobacter pylori infection: A meta-analysis

An¹,

Wang²,

Wu³

et al. 2018

WJG

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“…Two other original studies also compared fluoroquinolone‐based triple therapy to standard triple therapy. A study from Turkey noted that the per‐protocol (PP) eradication rate was 92% in a levofloxacin triple therapy group, 92% in a moxifloxacin triple therapy group, and 82% in a clarithromycin triple therapy group, a statistically significant difference for the combined fluoroquinolone‐containing groups over clarithromycin . A study from Taiwan also showed a clear benefit for levofloxacin‐based 7‐day triple therapy compared to clarithromycin‐based treatment (78 vs 58%) .…”

Section: Fluoroquinolonesmentioning

confidence: 99%

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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“…The H. pylori eradication rate of standard triple therapy has been shown to be low in Turkey. The eradication rate of this regimen was 63.6% in the study of Avşar et al, 57% in the study of Polat et al and 82.4% in the study of Rakici et al [7][8][9]. In the study of Rakici et al, eradication of H. pylori was assessed by stool antigen testing, which may lead to false negative results due to standardization issues [10].…”

Section: Resultsmentioning

confidence: 99%

Comparison of the efficacy of six different Helicobacter pylori eradication regimens: greater than or equal to another

Sezıklı¹,

Şirin²,

Çetinkaya³

et al. 2018

biomedicalresearch

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Objective: This study aimed to compare H. pylori eradication rates of different therapy regimens that are commonly used and investigated. Methods: The study included 210 patients with H. pylori positive nonulcer dyspepsia, who were randomised into 6 groups. Group 1: Rabeprazole 20 mg BID+amoxicillin 1000 mg BID for the first 7 d and rabeprazole 20 mg BID+amoxicillin 1000 mg BID+clarithromycin 500 mg BID+metronidazole 500 mg TID for the second 7 d. Group 2: Rabeprazole 20 mg BID+amoxicillin 1000 mg BID for the first 5 d and rabeprazole 20 mg BID+clarithromycin 500 mg BID+metronidazole 500 mg TID for the second 5 d. Group 3: Rabeprazole 20 mg BID+metranidazole 500 mg TID+tetracycline 500 mg QID+bismuth QID for 14 d. Group 4: Rabeprazole 20 mg BID+clarithromycin 500 mg BID+amoxicillin 1000 mg BID for 14 d. Group 5: Rabeprazole 20 mg BID+amoxicillin 1000 mg BID+clarithromycin 500 mg BID +metronidazole 500 mg TID for 7 d. Group 6: Rabeprazole 20 mg BID+amoxicillin 1000 mg BID +clarithromycin 500 mg BID+metronidazole 500 mg TID for 14 d. Results: H. pylori eradication rates were 65.6%, 68.6%, 56.7%, 51.4%, 65.6% and 62.9% respectively, included in the ITT analysis, and 68.6%, 68.6%, 62.9%, 51.4%, 68.6% and 62.9% respectively, included in the PP analysis for all groups. There was no significant difference between the groups with regard to eradication rates. Conclusion: Although H. pylori eradication rates of hybrid, sequential and concomitant therapy regimens were higher than those of quadruple and standard triple therapy regimens, they were also far from the ideal rate.

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Comparison of Levofloxacin- and Moxifloxacin-Based Triple Therapies with Standard Treatment in Eradication of Helicobacter Pylori as First-Line Therapy

Cited by 14 publications

References 21 publications

Fourth-generation quinolones in the treatment of Helicobacter pylori infection: A meta-analysis

Fourth-generation quinolones in the treatment of Helicobacter pylori infection: A meta-analysis

Treatment of Helicobacter pylori Infection 2015

Comparison of the efficacy of six different Helicobacter pylori eradication regimens: greater than or equal to another

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