Levofloxacin versus clarithromycin in a 10 day triple therapy regimen for first-line Helicobacter pylori eradication: a single-blind randomized clinical trial

Aim: It is recommended that treatments that include clarithromycin should be avoided in eradication of Helicobacter pylori (HP) in cases where clarithromycin resistance is higher than 20%. We aimed to compare levofloxacin- and moxifloxacin-based triple therapies with standard treatment and with each other in eradication of helicobacter pylori as first-line therapy. Materials and Methods: Patients were randomized prospectively as three groups. There were 102 patients in the levofloxacin group, 101 patients in the moxifloxacin group, and 103 patients in the standard treatment group. The patients received levofloxacin 500 mg daily, amoxicillin 1 g b.i.d. and lansoprazole 30 mg b.i.d. for ten days (LAL) in the levofloxacin group; moxifloxacin 400 mg daily, amoxicillin 1 g b.i.d. and lansoprazole 30 mg b.i.d. (MAL) in the moxifloxacin group; and clarithromycin 500 mg b.i.d., amoxicillin 1 g b.i.d. and lansoprazole 30 mg b.i.d. (CAL) in the standard treatment group. At post-treatment week 6, HP was checked by using stool antigen test. Results: In the eradication of Helicobacter pylori, the success rate as determined by per protocol (PP) analysis was 92% in the LAL group, 91.8% in the MAL group, and 82.4% in the CAL group. A statistically significant difference was found in the LAL and MAL groups compared to the CAL group (p < 0.05). There was no difference between the LAL and MAL groups. Conclusions: It was determined that levofloxacin- and moxifloxacin-based triple therapies were more effective than the standard treatment in first-line setting in the eradication of Helicobacter pylori. In addition, no difference was found between levofloxacin- and moxifloxacin-based triple therapies. Currently observed high efficacy may be evaluated in treatment. Although quinolon resistance is not considered a major problem, it appears to be a factor that may reduce treatment success over a period of time.

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“…Similar rates are reported for moxifloxacin resistance [16,17,18,19,20]. Quinolon resistance increases with age and duration of use.…”

Section: Discussionsupporting

confidence: 79%

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

Rakici

Ayaz²,

Akdoğan³

et al. 2014

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“…Boyanova et al (41) reported an 8% metronidazole/clarithromycin resistance rate in H. pylori strains. In a study performed in 2012 in Spain, the authors reported an 18.1% multidrug resistance rate, with the metronidazole/quinolone resistant phenotype as the predominant phenotype (3) . In the present study, multiple resistance was observed in 52.7% (19/36) of the 36 clarithromycin-resistant strains.…”

Section: Financial Supportmentioning

confidence: 99%

“…Helicobacter pylori is thought to be involved in the pathogenesis of gastritis, peptic ulcer disease, gastric cancer, mucosa-associated lymphoid tissue lymphoma and various extra-gastrointestinal manifestations (1) (2) (3) . Unfortunately, emerging bacterial resistance causes treatment problems, leading to a search for new treatment regimens.…”

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confidence: 99%

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Antimicrobial resistance of Helicobacter pylori strains to five antibiotics, including levofloxacin, in Northwestern Turkey

Caliskan

Tokman

Erzın

et al. 2015

Rev. Soc. Bras. Med. Trop.

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Introduction: Antibiotic resistance is the main factor that affects the effi cacy of current therapeutic regimens against Helicobacter pylori. This study aimed to determine the rates of resistance to effi cacy clarithromycin, amoxicillin, tetracycline, levofl oxacin and metronidazole among H. pylori strains isolated from Turkish patients with dyspepsia. Methods: H. pylori was cultured from corpus and antrum biopsies that were collected from patients with dyspeptic symptoms, and the antimicrobial susceptibility of H. pylori was determined using the E-test (clarithromycin, amoxicillin, tetracycline, metronidazole and levofl oxacin) according to the EUCAST breakpoints. Point mutations in the 23S rRNA gene of clarithromycin-resistant strains were investigated using realtime PCR. Results: A total of 98 H. pylori strains were isolated, all of which were susceptible to amoxicillin and tetracycline. Of these strains, 36.7% (36/98) were resistant to clarithromycin, 35.5% (34/98) were resistant to metronidazole, and 29.5% (29/98) were resistant to levofl oxacin. Multiple resistance was detected in 19.3% of the isolates. The A2143G and A2144G point mutations in the 23S rRNA-encoding gene were found in all 36 (100%) of the clarithromycin-resistant strains. Additionally, the levofl oxacin MIC values increased to 32 mg/L in our H. pylori strains. Finally, among the clarithromycin-resistant strains, 27.2% were resistant to levofl oxacin, and 45.4% were resistant to metronidazole. Conclusions: We conclude that treatment failure after clarithromycin-or levofl oxacinbased triple therapy is not surprising and that metronidazole is not a reliable agent for the eradication of H. pylori infection in Turkey.

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“…The 2012 Maastricht consensus guideline recommends the levofloxacin-PPI containing regimen for patients who have failed standard first-line treatment [2]. Many studies have examined levofloxacin-PPI as a first-line therapy for eradication of H pylori infection [8]–[10]. However, the eradication rates achieved with first-line levofloxacin-based treatments are not uniform.…”

Section: Introductionmentioning

confidence: 99%

Levofloxacin-Based First-Line Therapy versus Standard First-Line Therapy for Helicobacter pylori Eradication: Meta-Analysis of Randomized Controlled Trials

2014

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BackgroundFirst-line levofloxacin-based treatments eradicate Helicobacter pylori with varying success. We examined the efficacy and safety of first-line levofloxacin-based treatment in comparison to standard first-line therapy for H pylori eradication.Materials and MethodsWe searched literature databases from Medline, EMBASE, and the Cochrane Register of Randomized Controlled Trials through March 2013 for randomized controlled trials comparing first-line levofloxacin and standard therapy. We included randomized controlled trials conducted only on naïve H pylori infected patients in adults. A systematic review was conducted. Meta-analysis was performed with Review Manager 5.2. Treatment effect was determined by relative risk with a random or fixed model by the Mantel-Haenszel method.ResultsSeven trials were identified with 888 patients receiving 7 days of first-line levofloxacin and 894 treated with standard therapy (Amoxicillin, Clarithromycin and proton pump inhibitor) for 7 days. The overall crude eradication rate in the Levofloxacin group was 79.05% versus 81.4% in the standard group (risk ratio 0.97; 95% CI; 0.93, 1.02). The overall dropout was 46 (5.2%) in the levofloxacin group and 52 (5.8%) for standard therapy. The dizziness was more common among group who took Levofloxacin based treatment and taste disturbance was more common among group who took standard therapy. Meta-analysis of overall adverse events were similar between the two groups with a relative risk of 1.06 (95% CI 0.72, 1.57).Conclusion Helicobacter pylori eradication with 7 days of Levofloxacin-based first line therapy was safe and equal compared to 7 days of standard first-line therapy.

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Levofloxacin versus clarithromycin in a 10 day triple therapy regimen for first-line Helicobacter pylori eradication: a single-blind randomized clinical trial

Abstract: Levofloxacin-based treatment for H. pylori infection did not improve upon the eradication rate of the standard clarithromycin-based triple therapy in this study. This may reflect the progressive increase in in vitro resistance rates to levofloxacin observed in our region.

Cited by 19 publications

References 30 publications

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

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

Antimicrobial resistance of Helicobacter pylori strains to five antibiotics, including levofloxacin, in Northwestern Turkey

Levofloxacin-Based First-Line Therapy versus Standard First-Line Therapy for Helicobacter pylori Eradication: Meta-Analysis of Randomized Controlled Trials

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