Levofloxacin-based therapy as an efficient alternative for eradicating Helicobacter pylori infection in Iran: a systematic review and meta-analysis

Keikha, Masoud; Askari, Parvin; Ghazvini, Kiarash

doi:10.1016/j.jgar.2021.10.019

Cited by 16 publications

(10 citation statements)

References 74 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Rimbara et al indicated that a gyrB mutation at position 463 might also induce Hp resistance to fluoroquinolone (Rimbara et al, 2012). The literature shows that mutations in 87, 88, 91, and 97 positions of gyrA are the most common (Rimbara et al, 2012;Shetty et al, 2019;Keikha et al, 2022).…”

Section: Single-drug Resistance Mechanismsmentioning

confidence: 99%

Multidrug resistance in Helicobacter pylori infection

et al. 2023

View full text Add to dashboard Cite

Helicobacter pylori (Hp), a well-known human pathogen, causes one of the most common chronic bacterial infections and plays an important role in the emergence of chronic progressive gastric inflammation and a variety of gastrointestinal diseases. The prevalence of Hp infection varies worldwide and is indirectly proportional to socio-economic status, especially during childhood. The response to the eradication therapy significantly depends on the antibiotic resistance specific to each geographical region; thus, currently, given the increasing prevalence of antimicrobial resistance (especially to clarithromycin, metronidazole, and levofloxacin), successful treatment for Hp eradication has become a real challenge and a critical issue. The most incriminated factors associated with multidrug resistance (MDR) in Hp proved to be the overuse or the improper use of antibiotics, poor medication adherence, and bacterial-related factors including efflux pumps, mutations, and biofilms. Up to 30% of first-line therapy fails due to poor patient compliance, high gastric acidity, or high bacteremia levels. Hence, it is of great importance to consider new eradication regimens such as vonoprazan-containing triple therapies, quintuple therapies, high-dose dual therapies, and standard triple therapies with probiotics, requiring further studies and thorough assessment. Strain susceptibility testing is also necessary for an optimal approach.

show abstract

Section: Single-drug Resistance Mechanismsmentioning

confidence: 99%

Multidrug resistance in Helicobacter pylori infection

et al. 2023

View full text Add to dashboard Cite

show abstract

“…Currently, six therapeutic groups which were established according to the most frequently prescribed treatments are available for the treatment of H. pylori, including (1) PPI‐C + A/M, (2) quadruple therapy sequential: PPI‐C + A + M/T, (3) quadruple therapy concomitant: PPI‐C + A + M/T, (4) PPI‐M/T + Tc + B, either as three‐in‐one single capsule or in the traditional scheme, (5) PPI‐C + A + B, and (6) the “other” group contained the dual and hybrid therapies (in which, PPI, C, A, M, T, Tc, and B represents proton pump inhibitors, Clarithromycin , Amoxicillin , Metronidazole , Tinidazole , Tetracycline , and Bismuth , respectively) 8,9 . However, acquired antibiotic resistance has been extensively reported 10 and was closely associated with increased risk of treatment failure in both triple therapy and quadruple therapy 11 . More importantly, unsuccessful, or insufficient treatment of H. pylori contributes to the development of gastric adenocarcinoma and metachronous recurrence 12,13 .…”

Section: Introductionmentioning

confidence: 99%

Network meta‐analysis of different dosages of esomeprazole and rabeprazole for the treatment of Helicobacter pylori

et al. 2023

View full text Add to dashboard Cite

Helicobacter pylori (H. pylori) is an extracellular bacterium, which resides in the human gastric submucosa. 1 Studies indicated H. pylori is the main causative agent of gastrointestinal disorders, such as chronic gastritis, peptic ulcer, preneoplastic lesions, mucosa-associated lymphoid tissue (MALT) lymphoma, and gastric cancer. 2,3 Because H. pylori is a controllable risk factor of gastric lesions, 4-6 successful cure of H. pylori is therefore considered as an effective approach for preventing gastrointestinal disorders. 7 Currently, six therapeutic groups which were established according to the most frequently prescribed treatments are available

show abstract

“…According to the Kyoto Global Consensus Conference, eradication of H. pylori infection among the asymptomatic subjects seems an necessity [ 4 ]. Nevertheless, the rate of the treatment for H. pylori infection is declining annually; the emergence of clarithromycin-resistant strains has been declared a global threat by the World Health Organization (WHO) [ 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

“…The vacA s1/m1 genotype possess the highest toxicity property for host cells, while the vacA s2/m2 genotype biologically is inactive [ 12 , 13 ]. CagA is encoded by cagA gene; this toxin is highly immunogenic, and upon entering the host cell, it activates kinases through EPIYA motifs in its C-terminal, which in turn disrupt signaling pathways [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

Clinical relevance of the cagA and vacA s1m1 status and antibiotic resistance in Helicobacter pylori: a systematic review and meta-analysis

2022

Self Cite

View full text Add to dashboard Cite

Background The role of Helicobacter pylori (H. pylori) virulence factors of such as vacA s1m1 and cagA in designating clinical outcomes and eradication rate has been deeply challenged in the last decade. The goal of this analysis was to identify the potential relevance between cagA and vacA genotypes with reported antibiotic resistance observed in clinical H. pylori isolates. Methods This literature search was conducted in databases such as Clarivate analytics, PubMed, Scopus, EMBASE, DOAJ, and Google Scholar by April 2022, regardless of language restrictions and publication date. Quality of the included studies was assessed by the Newcastle–Ottawa scale. Statistical analysis of retrieved studies was fulfilled using Comprehensive Meta-Analysis software version 2.2. Following quality appraisal of eligible studies, potential association between the status of cagA and vacA genes with resistance to clarithromycin, metronidazole, amoxicillin, tetracycline, and levofloxacin was measured using odds ratio with 95% confidence interval. We also used sensitivity analyses and meta-regression to eliminate the source of heterogeneity from the overall estimates. Publication bias was assessed using funnel plot, Egger’s test, Begg’s test with the trim and fill procedure to assess the presence and magnitude of publication bias in the included studies. Results Our findings suggested that a significant relationship between cagA status ‎and increase resistance ‎to metronidazole (OR: 2.69; 95% CI: 1.24–5.83‎‏‎). In subgroup analysis, we ‎found that in the Western ‎population, infection with cagA-positive strains could be led to increase in ‎the resistance to ‎metronidazole (OR: 1.59; 95% CI: ‎0.78–3.21‎‏‎), ‎amoxicillin (OR: ‎19.68‎; 95% CI: 2.74–‎‎141.18), ‎and ‎levofloxacin (OR: ‎11.33; 95% CI: ‎1.39–‎‎91.85). After implementation of trim and fill method, the adjusted OR was not significantly differed from original estimates which in turn represented our subgroup analysis was statistically robust. On the other hand, vacA ‎genotypes usually ‎reduce the antibiotic resistance of this bacterium, so that vacA s1m1 significantly reduces the ‎resistance to ‎metronidazole (OR: 0.41; 95% CI: 0.20–0.86‎‏‎). Surprisingly, resistance of vacA s2m2 strains to antibiotics was low, the reason may be due ‎to the non-inflammatory properties of strains containing vacA s2m2. The meta-regression and sensitivity analyses successfully reduced the effect of heterogeneity from the overall estimates. In addition, although the pooled OR is reduced after trim and fill adjustment but results do not change the conclusion regarding vacA genotypes and antibiotic resistance. Conclusions According to our findings, it was clearly demonstrated that cagA-positive strains are resistance to metronidazole, especially in Western countries. In Western countries, vacA s1m1 increases resistance to amoxicillin and levofloxacin. Based on the present findings, the vacA s1m1 genotype significantly increases resistance to metronidazole, while the vacA s1m2 decreases resistance to clarithromycin and metronidazole. Resistance to antibiotics in less virulent (vacA s2m2) strains is statistically significant lower than others.

show abstract

Levofloxacin-based therapy as an efficient alternative for eradicating Helicobacter pylori infection in Iran: a systematic review and meta-analysis

Cited by 16 publications

References 74 publications

Multidrug resistance in Helicobacter pylori infection

Multidrug resistance in Helicobacter pylori infection

Network meta‐analysis of different dosages of esomeprazole and rabeprazole for the treatment of Helicobacter pylori

Clinical relevance of the cagA and vacA s1m1 status and antibiotic resistance in Helicobacter pylori: a systematic review and meta-analysis

Contact Info

Product

Resources

About