High Efficacy of Levofloxacin-Dexlansoprazole-Based Quadruple Therapy as a First Line Treatment for Helicobacter pylori Eradication in Thailand

Abstract

Background: Levofloxacin is an effective medication for second line Helicobacter pylori (H. pylori) eradication. However, limited studies have approved its use as an effective antibiotic in first line therapy. Dexlansoprazole is a new PPI and lacks of evidence in support of a role in H. pylori eradication. This study was designed to evaluate efficacy of levofloxacin-dexlansoprazole-based quadruple therapy for H. pylori eradication in Thailand. Materials and Methods: This prospective randomized control study was performed during June 2014 to December 2014. H. pylori infected gastritis patients were randomized to receive 7-or 14-day levofloxacin-dexlansoprazole based on quadruple therapy (levofloxacin 500 mg OD, dexlansoprazole 60 mg bid, clarithromycin MR 1000 mg OD, bismuth subsalicylate 1048 mg bid). CYP2C19 genotyping and antibiotic susceptibility tests were conducted for all patients. A 13C urea breath test was performed to confirm H. pylori eradication at least 4 weeks after treatment. Results: A total of 100 patients were enrolled, comprising 44 males and 56 females (mean age of 52.6 years). Eradication rate by PP analysis was 85.7% (42/49) with the 7-day regimen and 98% (48/49) with the 14-day regimen (85.7% vs 98%; p-value=0.059). ITT analysis was 84% and 96% with 7-and 14-day regimens, respectively (84% vs 96%; p-value=0.092). Antibiotic susceptibility testing demonstrated 35.1% resistance to metronidazole, 18.3% to clarithromycin, and 13.5% to levofloxacin. CYP2C19 genotyping revealed 54.1% RM, 34.7% IM and 11.2% PM. The 14-day regimen provided 100% eradication in patients with clarithromycin or dual clarithromycin and metronidazole H. pylori resistant strains. Moreover, the eradication rate was 96.6% in patients with CYP2C19 genotype RM. Conclusions: The 14-day levofloxacin-dexlansoprazole based quadruple therapy provides high H. pylori eradication regardless of CYP2C19 genotype, clarithromycin or dual clarithromycin and metronidazole resistant strains. This regimen could be use as an alternative first line therapy for H. pylori eradication in Thailand.

Once‐daily rabeprazole, levofloxacin, clarithromycin‐MR, and bismuth for Helicobacter pylori eradication: A randomized study of 7 or 14 days (ONCE study)

“… We previously showed that genotype RM was the most common genotype in Thailand. Rabeprazole has no significant effects on most cytochrome P450 enzyme systems and may be one of the preferred PPIs in areas where the prevalence of PPI rapid metabolizers is high. In this study, the prevalence of CYP2C19 genotype was similar among study groups.…”

“… The global eradication rate of standard triple regimen for H pylori infection has declined to where it is no longer recommended as an empiric choice in most countries. In some regions, levofloxacin‐containing triple or quadruple therapies have proved successful for H pylori eradication but the rapid increase in fluoroquinolone resistance has begun to limit fluoroquinolone use . Successful therapy depends on many factors including adherence, antibiotic resistance, dose of proton‐pump inhibitor (PPI), and duration of therapy.…”

Antibiotic Resistant Pattern of Helicobacter Pylori Infection Based on Molecular Tests in Laos

“…Fluoroquinolone such as levofloxacin and moxifloxacin, was introduced to be effective drugs for treating H. pylori infection. However, fluoroquinolone resistance is now a growing problem and impact on the eradication rate in many countries (Vilaichone et al, 2013;Prapitpaiboon et al, 2015). H. pylori resistance to clarithromycin and fluoroquinolone was related with mutation points that can be tested by molecular technique.…”

Comparation of Bioavailability: Two Dexlansoprazole Formulations in Beagle Dogs after a Single Dose Administration

“…This regimen could be used as an alternative first line therapy for H. pylori eradication. Dexlansoprazole appears to be effective in improving heartburn, regurgitation and maintained for the duration of the treatment [6,7].…”

“…It was reported that early detection, timely and effectively take antibiotics could prevent and control upper digestive system diseases to a great extent. Years past H. pylori has been found to be a bacteria which is difficult to treat, and it also obtained the resistance of common used antibiotics [1][2][3][4][5][6].…”