Fluoroquinolone Sequential Therapy for <i>Helicobacter pylori</i>: A Meta‐analysis

Kale-Pradhan, Pramodini; Mihaescu, Anela; Wilhelm, Sheila M.

doi:10.1002/phar.1614

Cited by 13 publications

(11 citation statements)

References 37 publications

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“…These factors have no impact on the eradication of H. pylori. Results of our study are consistent with the results of other studies (Kale-Pradhan et al, 2015;Moradniani et al, 2017a;Moradniani et al, 2017b;Polat et al, 2012;Romano et al, 2010). However some studies have shown that age and cigarette smoking may have an impact on the eradication rate of H. pylori infection (Eisig et al, 2011;Molina-Infante et al, 2010).…”

Section: Discussionsupporting

confidence: 93%

“…Our study shows that the lev-seq regimen is much more effective than the triple therapy regimen. The results of our study are quite consistent with other studies that have been done in other country (Kale-Pradhan et al, 2015;Molina-Infante et al, 2010;Ozdil et al, 2011;Romano et al, 2010). A recent meta-analysis reported the eradication rate of lev-seq regimen as 87.8% and the eradication rate using triple therapy as 71% (Gatta et al, 2013).…”

Section: Discussionsupporting

confidence: 92%

“…In a recent study in Iran, it was reported that resistance to levofloxacin was 3.5% (Khademi et al, 2015). Levofloxacin is a fluoroquinolone drug which influences H. pylori strains that are resistant to clarithromycin (Kale-Pradhan et al, 2015). Sequential regimens based on levofloxacin is a viable option and can be an ideal alternative for the treatment of H. pylori infection, especially in areas where resistance to clarithromycin is high (Kale-Pradhan et al, 2015;Malfertheiner et al, 2017).…”

Section: Discussionmentioning

confidence: 99%

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Levofloxacin-based sequential therapy versus classic triple therapy in Helicobacter pylori eradication: A randomized clinical trial

et al. 2017

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Introduction: During the past two decades, eradication rates with triple therapy for Helicobacter (H.) pylori eradication have decreased. The decline of effectiveness of the triple therapy have led to investigations to achieve more effective and safe therapeutic strategies. Sequential, concomitant and hybrid therapeutic regimens are new therapies that have been introduced over the past two decades. The purpose of this study was to compare levofloxacin-based sequential therapy versus classic triple therapy in H. pylori eradication in a randomized clinical trial. Methods: All eligible cases were divided into two groups using a randomized block method. The first group (classic group) was treated with triple therapy; patients received omeprazole, amoxicillin and clarithromycin for 14 days. The second group received the levofloxacin-based sequential (lev-seq) regimen; the patients were treated with omeprazole and amoxicillin for the first 7 days and then with omeprazole, levofloxacin and metronidazole for the latter 7 days. In this clinical trial, 200 patients with H. pylori infection were enrolled. Ultimately, 192 patients completed the study. Of these, 95 patients (46 males and 49 females) were treated with triple therapy (classic group) and 97 patients (46 males and 51 females) were treated with the lev-seq regimen. The average age in the classic group and lev-seq groups were 41.4±12.4 years and 40.2±11.8 years, respectively. Results: The levofloxacin based sequential regimen was more effective than triple therapy regimen. It is recommended that the lev-seq regimen be used as the first-line therapy, especially in areas with high levels of resistance to clarithromycin (over 20%). Conclusion: Further studies with large numbers of samples are required to be conducted in different parts of the country for further evaluation of efficacy of this regimen. Peer Review Details Peer review method: Single-Blind (Peer-reviewers: 02) Peer-review policy Plagiarism software screening?: Yes Date of Original Submission: 05 November 2017 Date accepted: 25 November 2017 Peer reviewers approved by: Dr. Lili Hami Editor who approved publication: Dr. Phuc Van Pham

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

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Levofloxacin-based sequential therapy versus classic triple therapy in Helicobacter pylori eradication: A randomized clinical trial

et al. 2017

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“…Other studies showed the same superiority for Levofloxacin-based triple and sequential regimens [ 11 – 14 ]. A recently published meta-analysis compared Levofloxacin-based sequential therapy and Clarithromycin-based triple and sequential treatment, and revealed superiority for the regimens that included fluoroquinolones (87.8% vs. 71.1%, respectively) [ 15 ]. This is probably due to the very low resistance to Levofloxacin reported in such studies (as low as 3.7% in the Italian study by Romano et al [ 10 ]).…”

Section: Discussionmentioning

confidence: 99%

Levofloxacin or Clarithromycin-based quadruple regimens: what is the best alternative as first-line treatment for Helicobacter pylori eradication in a country with high resistance rates for both antibiotics?

et al. 2017

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Background Helicobacter pylori eradication rates in Portugal are declining, due to increased resistance of this bacterium to antimicrobial agents, especially Clarithromycin. Quadruple Levofloxacin-containing regimens could be an option for first-line treatment, but its efficacy should be evaluated as fluoroquinolone resistance is rapidly increasing.Our aim was to compare the efficacy of Clarithromycin and Levofloxacin-based sequential quadruple therapies as first-line treatment options and determine factors associated with treatment failure.MethodsA total of 200 Helicobacter pylori infected patients were retrospectively included (female 57.5%; average age: 53.2 ± 15.7) and received either 10-day sequential therapy (Proton-Pump Inhibitor + Amoxicillin 1 g bid for 5 days and Proton-Pump Inhibitor + Clarithromycin 500 mg + Metronidazole/Tinidazole 500 mg bid/tid in the following 5 days; group A) or a 10-day modified sequential therapy with Levofloxacin 500 mg id instead of Clarithromycin (group B). Eradication was confirmed with urea breath test. Variables that could influence success rate were analyzed.ResultsThere were no differences between groups in terms of gender, age, smoking habits and indications for treatment. The eradication rate obtained with Clarithromycin-based sequential treatment was significantly higher than with Levofloxacin-based therapy (90%, CI95%: 84–96% vs. 79%, CI95%: 71–87%, p = 0.001). Using full-dose proton-pump inhibitor and high-dose Metronidazole in group A, and full-dose proton-pump inhibitor and prescription from a Gastroenterologist in group B were associated with eradication success.ConclusionsTen-day Levofloxacin-based sequential treatment achieved inadequate efficacy rate (<80%) and should not be adopted as first-line therapy. Standard sequential therapy showed significantly better results in this naïve population. Using full-dose proton-pump inhibitor and higher doses of Metronidazole is essential to achieve such results.Electronic supplementary materialThe online version of this article (doi:10.1186/s12876-017-0589-6) contains supplementary material, which is available to authorized users.

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“…One promising approach is sequential therapy 16 . This regimen consists of 5 days of amoxicillin and a PPI, followed by an additional 5 days of PPI plus tinidazole and clarithromycin..Basis for this regimen is that by reducing bacterial load in first 5 days efficacy of tinidazole and clarithromycin increases.…”

Section: Doimentioning

confidence: 99%

Comparative study of sequential therapy versus standard triple therapy versus quinolone-based triple therapy for eradication of Helicobacter pylori infection

2017

Int. J. Curr. Res. Med. Sci.

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Introduction: H. pylori is a gram-negative bacillus that has naturally colonized humans. Essentially all H. pyloricolonized persons have gastric tissue responses, but fewer than 15% develop associated illnesses such as peptic ulceration, gastric adenocarcinoma, or gastric lymphoma. Worldwide, more than 80% of duodenal ulcers and more than 60% of gastric ulcers are related to H. pylori colonization. Although H. pylori is susceptible to a wide range of antibiotics in vitro, monotherapy is not usually successful. Failure of monotherapy has prompted the development of multidrug regimens, the most successful of which are triple and quadruple combinations. Aims and Objectives: To compare efficacy of Sequential Therapy versus Standard Triple Therapy versus Quinolone-based Triple Therapy for eradication of Helicobacter Pylori infection. Methods: The study included 150 patients attending OPD / admitted in various wards of a tertiary care hospital diagnosed to be helicobacter pylori positive by rapid urease test, after obtaining informed consent. The patients were then be randomly divided into three groups each of 50, one had received Sequential Therapy, other triple therapy and third quinolone based therapy. Results and conclusion: Sequential therapy group had better eradication rates (90%) as compared to standard triple therapy group (86%) and fluroquinolone therapy group (82%) but results were not statistically significant when all three groups were compared together.

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Fluoroquinolone Sequential Therapy for Helicobacter pylori: A Meta‐analysis

Abstract: Fluoroquinolone-based sequential therapy is a reasonable treatment alternative to first-line eradication therapy for treatment of H. pylori.

Cited by 13 publications

References 37 publications

Levofloxacin-based sequential therapy versus classic triple therapy in Helicobacter pylori eradication: A randomized clinical trial

Levofloxacin-based sequential therapy versus classic triple therapy in Helicobacter pylori eradication: A randomized clinical trial

Levofloxacin or Clarithromycin-based quadruple regimens: what is the best alternative as first-line treatment for Helicobacter pylori eradication in a country with high resistance rates for both antibiotics?

Comparative study of sequential therapy versus standard triple therapy versus quinolone-based triple therapy for eradication of Helicobacter pylori infection

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