Quinolone-Containing Therapies in the Eradication ofHelicobacter pylori

Abstract

Fluoroquinolones, especially levofloxacin, are used in the eradication of Helicobacter pylori worldwide. Many consensus guidelines recommend that the second-line rescue therapy for H. pylori eradication consists of a proton pump inhibitor, a quinolone, and amoxicillin as an option. Unfortunately, quinolone is well associated with a risk of developing bacterial resistance. In this paper, we review quinolone-containing H. pylori eradication regimens and the challenges that influence the efficacy of eradication. It is generally suggested that the use of levofloxacin should be confined to “rescue” therapy only, in order to avoid a further rapid increase in the resistance of H. pylori to quinolone. The impact of quinolone-containing H. pylori eradication regimens on public health issues such as tuberculosis treatment must always be taken into account. Exposure to quinolone is relevant to delays in diagnosing tuberculosis and the development of drug resistance. Extending the duration of treatment to 14 days improves eradication rates by >90%. Tailored therapy to detect fluoroquinolone-resistant strains can be done by culture-based and molecular methods to provide better eradication rates. Molecular methods are achieved by using a real-time polymerase chain reaction to detect the presence of a gyrA mutation, which is predictive of treatment failure with quinolones-containing triple therapy.

Clarithromycin versus Gemifloxacin in Quadruple Therapeutic Regimens for Helicobacter Pylori Infection Eradication

“…17,18 A possible cross resistance between clarithromycin and erythromycin, an antibiotic that has been widely prescribed for various infections in Iran for many years, may partially explain the unexpectedly high resistance rate of clarithromycin. 18 …”

The efficacy of a 14-day modified quadruple therapy containing amoxicillin, tetracycline and high dose metronidazole and proton-pump inhibitors as an empirical third line helicobacter pylori eradication treatment in Taiwan

“…One biopsy specimen from the antrum and one from the corpus were obtained for H. pylori isolation using previously described culture methods (10, 11). The biopsy specimens were cultured on plates that contained Brucella chocolate agar with 7% sheep blood and were incubated for 4-5 d under micro-aerobic conditions.…”

“…However, H pylori may develop resistance to the prescribed antibacterial like clarithromycin as standard first line therapy and may acquire resistance by acquisition and recombination of genes from other bacteria (7). The resistance battle against H. pylori continue, many people still abuse self-medication of antibiotic like levofloxacin, which helps H. pylori to develope more drugs resistances (8–10).…”

New insights into resistance of Helicobacter pylori against third‐ and fourth‐generation fluoroquinolones: A molecular docking study of prevalent GyrA mutations

“…On the other hand, based on collective data from 65 countries of the WHO regions, the growing rate of antibiotic resistance in the prevalent H pylori strains worldwide has reached an alarming level. Levofloxacin (LVX), a third‐generation fluoroquinolone, is being prescribed since 2003, as a second‐line antibiotic to rescue previously failed treatments . Nevertheless, a worldwide resistance rate of over 15 percent against this compound has been reported and others have found it suboptimal and only effective if combined with antibiotics such as tetracycline …”