The efficacy of moxifloxacin-based triple therapy in treatment of Helicobacter pylori infection: a systematic review and meta-analysis of randomized clinical trials

Abstract

Recent evidence shows that moxifloxacin could exert an antimicrobial effect against Helicobacter pylori in both in vitro and in vivo models. To systematically evaluate whether moxifloxacin-containing triple therapy could improve eradication rates and reduce side effects in first-line or second-line anti-H. pylori treatment, eligible articles were identified by searches of electronic databases. We included all randomized trials comparing moxifloxacin-based triple therapy with standard triple or quadruple therapy during H. pylori eradication treatment. Statistical analysis was performed with Review Manager 5.0.10. Subanalysis/sensitivity analysis was also performed. We identified seven randomized trials (n=1263). Pooled H. pylori eradication rates were 79.03% (95%CI: 75.73-82.07) and 68.33% (95%CI: 64.44-72.04) for patients with moxifloxacin-based triple therapy or with standard triple or quadruple therapy, respectively (intention-to-treat analysis). The odds ratio (OR) was 1.82 (95%CI: 1.17-2.81), the occurrence of total side effects was 15.23% (95%CI: 12.58-18.20) and 27.17% (95%CI: 23.64-30.92) for groups with or without moxifloxacin, and the summary OR was 0.45 (95%CI: 0.26-0.77). In subgroup analyses, we noted that the second-line eradication rate in the moxifloxacin group was significantly higher than that in the quadruple therapy group (73.33 vs 60.17%, OR: 1.78, 95%CI: 1.16-2.73, P<0.001). However, there was no difference in first-line eradication treatment. Findings from this meta-analysis suggest that moxifloxacin-based triple therapy is more effective and better tolerated than standard triple or quadruple therapy. Therefore, a moxifloxacin-based triple regimen should be used in the second-line treatment of H. pylori infection.

Susceptibility of Helicobacter pylori to antibiotics in Chinese patients

“…Several other antibiotics have recently been used to eradicate H. pylori . Some studies have demonstrated that MFX, a fourth generation of quinolone drugs, could achieve a better efficacy of H. pylori eradication than CLR‐containing triple therapy and bismuth‐containing quadruple therapy when used as a first‐line and second‐line drugs, respectively . The eradication rate is closely associated with MFX resistance .…”

“…Some studies have demonstrated that MFX, a fourth generation of quinolone drugs, could achieve a better efficacy of H. pylori eradication than CLR-containing triple therapy and bismuthcontaining quadruple therapy when used as a first-line and second-line drugs, respectively. 15 The eradication rate is closely associated with MFX resistance. 16 Because there is cross-resistance of H. pylori to quinolone drugs, a single mutation of gyrA, the quinolone resistance-determining region, could result in the resistance to quinolones including MFX.…”

Two-week, high-dose proton pump inhibitor, moxifloxacin triple Helicobacter pylori therapy after failure of standard triple or non-bismuth quadruple treatments

“…Several meta-analyses have compared the efficacy and safety of moxifloxacin-containing triple therapy vs. bismuth-containing quadruple therapy for the treatment of persistent H. pylori infection, and have demonstrated that the moxifloxacin regimen is more effective and better tolerated [12,54,55]. On the other hand, administration of the quadruple regimen is relatively complex, while moxifloxacin-containing regimens (with amoxicillin and PPIs administered twice daily and moxifloxacin once daily) represent an encouraging simpler alternative.…”

Comparison of efficacy and safety of levofloxacin-containing versus standard sequential therapy in eradication of Helicobacter pylori infection in Korea

“…There have been considerable reports of the successful efficacy of fluoroquinolones, such as levofloxacin or moxifloxacin, in combination with PPI and amoxicillin in the treatment of H. pylori infection, both as the first-line and second-line treatment [34][35][36]. Recently, a few trials evaluating the eradication rate of a levofloxacin-containing sequential regimen in the eradication of H. pylori-infected patients were presented [25,[37][38][39].…”