Randomized Clinical Trial: Esomeprazole, Bismuth, Levofloxacin, and Amoxicillin or Cefuroxime as First-Line Eradication Regimens for Helicobacter pylori Infection

Fu, Wei; Song, Zhiqiang; Zhou, Liya; Xue, Yan; Yu, Di; Suo, Baojun; Tian, Xueli; Wang, Li

doi:10.1007/s10620-017-4564-4

Cited by 24 publications

(33 citation statements)

References 30 publications

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“…Both arms achieved similar eradication rates (84% vs 81%, p=0.513). 43 Together, these data suggest that substitution of amoxicillin with a cephalosporin may be an option for patients with a penicillin allergy. 2,9 However, eradications rates appear less than optimal for first-line therapy.…”

Section: Penicillin Allergymentioning

confidence: 90%

Section: Penicillin Allergymentioning

confidence: 99%

“…To our knowledge, only three studies have evaluated the use of a nonpenicillin β‐lactam antibiotic (e.g., cephalosporin) for the treatment of H. pylori . One small study of 12 patients found cefprozil monotherapy to be ineffective at eradicating H. pylori . Cefixime‐based triple therapy, consisting of cefixime (200–400 mg twice/day), a PPI, and clarithromycin, was moderately effective when administered as initial therapy to 49 patients in Italy .…”

Section: Penicillin Allergymentioning

confidence: 99%

“…[41][42][43] One small study of 12 patients found cefprozil monotherapy to be ineffective at eradicating H. pylori. 43 Cefixime-based triple therapy, consisting of cefixime (200-400 mg twice/day), a PPI, and clarithromycin, was moderately effective when administered as initial therapy to 49 patients in Italy. 38 The eradication rate was 71% (24/34) among patients receiving cefixime 200 mg twice/day and 73% (11/15) among patients receiving cefixime 400 mg twice/ day.…”

Section: Penicillin Allergymentioning

confidence: 99%

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Treatment of Helicobacter pylori in Special Patient Populations

et al. 2019

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Helicobacter pylori infection can lead to gastritis, gastric and duodenal ulcers, and gastric cancer. Consequently, complete eradication is the goal of therapy. First‐line therapy for H. pylori infection includes clarithromycin triple therapy (clarithromycin, proton pump inhibitor [PPI], and amoxicillin or metronidazole), bismuth quadruple therapy (bismuth salt, PPI, tetracycline, and metronidazole or amoxicillin), or concomitant therapy (clarithromycin, PPI, amoxicillin, and metronidazole). However, many patients have relative contraindications to the antibiotics included in these regimens, making therapy selection difficult. Furthermore, failure of initial therapy makes selection of second‐line therapy challenging due to concerns for potential resistance to agents included in the initial regimen. This review discusses H. pylori microbiology, including antibiotic resistance, and summarizes the existing evidence for first‐ and second‐line treatment regimens that may be considered for special populations such as patients with penicillin allergies, patients with or at risk for QTc‐interval prolongation, and patients who are pregnant, breastfeeding, or elderly.

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Section: Penicillin Allergymentioning

confidence: 90%

Section: Penicillin Allergymentioning

confidence: 99%

Section: Penicillin Allergymentioning

confidence: 99%

Section: Penicillin Allergymentioning

confidence: 99%

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Treatment of Helicobacter pylori in Special Patient Populations

et al. 2019

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“…One such study reported eradication rates of 86.7% for one week of quadruple therapy including bismuth and levofloxacin compared to 72.2% for clarithromycin and bismuth and 75.56% for levofloxacin‐based triple therapy in first‐line patients . A different Chinese group observed similar eradication rates for a bismuth‐based quadruple therapy whether amoxicillin or cefuroxime was used (83.5% vs 81.0%) …”

Section: Bismuth‐based Therapymentioning

confidence: 99%

Treatment of Helicobacter pylori infection 2017

et al. 2017

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Over the last decade, it has been widely reported that the success of Helicobacter pylori eradication treatment is falling. A steady decline was observed in the number of patients achieving eradication with standard first-line triple therapy of two antibiotics and a proton pump inhibitor [1][2][3]. It now appears that the first-line eradication therapies most commonly used in everyday clinical practice fall considerably short of the 80% intention-to-treat (ITT) eradication rates that are considered the minimal acceptable levels as recommended in the Maastricht guidelines [4]. Interestingly, two studies emerged from Asian centers in the last 12 months, which show that, in this part of the world at least, eradication levels using standard therapies remain close to 80%. A Malaysian study showed a standard 1-week pantoprazole, amoxycillin, and clarithromycin regimen to be well tolerated and highly efficacious with a per-protocol eradication rate of 84% [5]. A Japanese study showed remarkably consistent per-protocol eradication rates from 2001 to 2009 fluctuating between 75 and 78% for standard 7-day triple-therapy regimens [6]. A limit of many studies especially those including clarithromycin or levofloxacin is that H. pylori susceptibility to the drugs, which is the main prediction of failure, was not tested. LevofloxacinThe use of levofloxacin as a first-line therapy has been examined in great depth in the last year. Levofloxacin may be used as a substitute for clarithromycin in either a standard triple or sequential regimen. A large study comparing the antibiotics in either regimen shows a clear advantage to levofloxacin in both combinations. Per-protocol cure rates for triple therapy were 66% for omeprazole-clarithromycin-amoxycillin compared with 83% for omeprazole-levofloxacin-amoxycillin and 81% for omeprazole-amoxycillin-clarithromycin-metronidazole vs 85% for omeprazole-amoxycillin-levofloxacinmetronidazole, with no difference in compliance rates or adverse events [7]. It has been proposed that sequential levofloxacin-based regimens are of most benefit in areas where clarithromycin resistance is in excess of 15%, and another study in such an area showed eradication rates of 81% with clarithromycin sequential therapy compared with 96% with levofloxacin sequential therapy. A third arm in this study looked at the dose of levofloxacin required and illustrated no benefit in increasing the dose from 250 to 500 mg [8]. Indeed, another study went so far as to suggest that once-daily dosing of a levofloxacin-based triple regimen may be as efficacious as twice daily [9]. The literature from Asia also seems to support levofloxacin as a good alternative first-line therapy. A study on a triple regimen showed per-protocol eradication rates of 78% for standard clarithromycin-containing therapies compared with 83% for a levofloxacin-based regimen [10]. Another study from the Middle East looked at whether combining clarithromycin and levofloxacin in the same regimen could be Keywords Peptic ulcer disease, resistance, compli...

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Antofloxacin-based bismuth quadruple therapy is safe and effective in Helicobacter pylori eradication: A prospective, open-label, randomized trial

Zeng

Jiang

et al. 2021

Arab Journal of Gastroenterology

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Randomized Clinical Trial: Esomeprazole, Bismuth, Levofloxacin, and Amoxicillin or Cefuroxime as First-Line Eradication Regimens for Helicobacter pylori Infection

Cited by 24 publications

References 30 publications

Treatment of Helicobacter pylori in Special Patient Populations

Treatment of Helicobacter pylori in Special Patient Populations

Treatment of Helicobacter pylori infection 2017

Antofloxacin-based bismuth quadruple therapy is safe and effective in Helicobacter pylori eradication: A prospective, open-label, randomized trial

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