Sitafloxacin‐based third‐line rescue regimens for <i><scp>H</scp>elicobacter pylori</i> infection in <scp>J</scp>apan

Furuta, Takahisa; Sugimoto, Mitsushige; Kodaira, Chise; Nishino, Masafumi; Yamade, Mihoko; Uotani, Takahiro; Sahara, Shu; Ichikawa, Hitomi; Yamada, Takanori; Osawa, Satoshi; Sugimoto, Ken; Watanabe, Hiroshi; Umemura, Kazuo

doi:10.1111/jgh.12442

Cited by 31 publications

(40 citation statements)

References 31 publications

(55 reference statements)

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“…An RCT of 10‐day triple therapy with ESO (20‐mg bid), AMPC (500‐mg qid), and STFX (100‐mg bid) was graded D (81% [51/63]; 95% CI: 71.0–90.9%) . However, another RCT showed no difference in efficacy between 7‐ and 14‐day triple therapy with RPZ (10‐mg bid/qid), AMPC (500‐mg qid), and STFX (100‐mg bid) . A change in the dosage of AMPC from 750‐mg bid to 500‐mg qid and in the duration of V‐AS therapy was insufficient to achieve an eradication rate of 90–95%.…”

Section: Discussionmentioning

confidence: 99%

Randomized trial of vonoprazan‐based versus proton‐pump inhibitor‐based third‐line triple therapy with sitafloxacin for Helicobacter pylori

Sue

Shibata

Sasaki

et al. 2018

J of Gastro and Hepatol

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Section: Discussionmentioning

confidence: 99%

Randomized trial of vonoprazan‐based versus proton‐pump inhibitor‐based third‐line triple therapy with sitafloxacin for Helicobacter pylori

Sue

Shibata

Sasaki

et al. 2018

J of Gastro and Hepatol

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“…The levofloxacin resistance rate is also relatively high in East Asia, where there is also a higher prevalence of stomach cancer compared to other regions [122,123] . Sitafloxacin, which has lower minimum inhibitory concentration for H. pylori, and levofloxacin triple therapy combined with bismuth quadruple therapy have been suggested as solutions to this problem, although further evidence is required to establish this approach [122,124] .…”

Section: Quinolones To Existing Treatmentmentioning

confidence: 99%

Antibiotic treatment forHelicobacter pylori: Is the end coming?

Kim

Choi

Chung

2015

WJGPT

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Infection with the Gram-negative pathogen Helicobacter pylori (H. pylori ) has been associated with gastroduodenal disease and the importance of H. pylori eradication is underscored by its designation as a group I carcinogen. The standard triple therapy consists of a proton pump inhibitor, amoxicillin and clarithromycin, although many other regimens are used, including quadruple, sequential and concomitant therapy regimens supplemented with metronidazole, clarithromycin and levofloxacin. Despite these efforts, current therapeutic regimens lack efficacy in eradication due to antibiotic resistance, drug compliance and antibiotic degradation by the acidic stomach environment. Core tip: This article reviews the recent literature describing antibiotic resistance and trends in Helicobacter pylori (H. pylori ) treatment. As there is no effective conventional therapy, new treatments are being developed and bismuth quadruple, sequential, concomitant therapies are recommended as a first-line regimen in regions with high levels of clarithromycin resistance. Quinolones have also been used for H. pylori treatment, although the cure rate has gradually reduced with this approach. New therapeutic directions include probiotic supplementation, tailored therapy, novel agents, and nanotechnology.

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“…Newly developed fluoroquinolones, such as gemifloxacin, clinafloxacin, and sitafloxacin, have been studied and demonstrated favorable outcomes for treatment of H. pylori (27). In particular, sitafloxacin has been reported to show outstanding antimicrobial efficacy even for microorganisms with gyrA mutations (28,29). Unfortunately, sitafloxacin is still not available in most countries, including South Korea.…”

Section: Discussionmentioning

confidence: 99%

High Efficacy of Finafloxacin on Helicobacter pylori Isolates at pH 5.0 Compared with That of Other Fluoroquinolones

Lee

Kim

Nam

et al. 2015

Antimicrob Agents Chemother

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Finafloxacin is a novel fluoroquinolone with improved antimicrobial efficacy, especially in an acidic environment. The efficacy of finafloxacin for the inhibition of Helicobacter pylori infection was compared with the efficacies of levofloxacin and moxifloxacin at neutral and acidic pH. The impacts of gyrA point mutation on the efficacy of those three fluoroquinolones were also investigated. A total of 128 clinical H. pylori strains were utilized. MICs of levofloxacin, moxifloxacin, and finafloxacin were determined at pH 5.0 and pH 7.0 by the agar dilution method. The impact of gyrA point mutations that are responsible for fluoroquinolone resistance was analyzed; the results showed 50 strains with an Asn-87 point mutation, 48 strains with an Asp-91 point mutation, and the remaining 30 strains with no gyrA mutations. The use of finafloxacin led to MIC values at pH 5.0 that were lower than the values seen at pH 7.0 for 112 strains (112/128, 87.5%), and this proportion was higher than that seen with moxifloxacin (21/128, 16.4%, P < 0.001). Finafloxacin also demonstrated a rate of susceptibility (MIC, <1 g/ml) (37.5%, 48/128) at pH 5.0 that was higher than that seen with moxifloxacin (2.3%, 3/128) (P < 0.001). The trends were similar regardless of which of the Asn-87, Asp-91, and A2143 point mutations were present. In conclusion, the superior antimicrobial efficacy of finafloxacin against H. pylori in an acidic environment suggests the possible use of finafloxacin for treatment of H. pylori infection, as has been proposed by its developer, Merlion Pharma. Helicobacter pylori infection is a cause of recurrent peptic ulcer disease, chronic gastritis, and gastric malignancies (1). It has been proven that the eradication of H. pylori can prevent peptic ulcer recurrence (2). However, drug instability and insufficient diffusion to gastric mucosa and mucus in that highly acidic environment require the combination of antibiotics with a proton pump inhibitor (PPI) for H. pylori eradication (3). PPI-clarithromycin-containing triple therapy was the first-line eradication treatment until recently (4). However, as the failure rate of the 7-day triple therapy has increased progressively, sequential or concomitant therapy has come to be used (3, 5). Unfortunately, the 7-day triple therapy is still regarded as the standard primary therapy in South Korea because there is no proven alternative regimen that can provide more efficient and safer eradication (6, 7). The unsatisfactory response of alternative eradication regimens was mainly caused by antimicrobial resistance and was particularly due to clarithromycin resistance (5, 8). Therefore, the Maastricht IV consensus has recommended that PPI-clarithromycin-containing triple therapy without prior susceptibility testing should be avoided when the clarithromycin resistance rate is higher than 15% to 20% (2). Moreover, the current high prevalence of metronidazole resistance in South Korea (9) indicates the necessity of reestablishment of a new standard first-line eradication therapy.In...

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Sitafloxacin‐based third‐line rescue regimens for Helicobacter pylori infection in Japan

Abstract: All of the above-described rescue regimens proved relatively equally useful in the eradication of H. pylori. Of them, RAS for 2 weeks and RMS for 1 or 2 weeks could attain the rescue eradication rates higher than 90% by per-protocol analysis.

Cited by 31 publications

References 31 publications

Randomized trial of vonoprazan‐based versus proton‐pump inhibitor‐based third‐line triple therapy with sitafloxacin for Helicobacter pylori

Randomized trial of vonoprazan‐based versus proton‐pump inhibitor‐based third‐line triple therapy with sitafloxacin for Helicobacter pylori

Antibiotic treatment forHelicobacter pylori: Is the end coming?

High Efficacy of Finafloxacin on Helicobacter pylori Isolates at pH 5.0 Compared with That of Other Fluoroquinolones

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