A prospective evaluation of levofloxacin‐based triple therapy for refractory <i>Helicobacter pylori</i> infection in Australia

Katelaris, Peter; Katelaris, Annette

doi:10.1111/imj.13432

Cited by 12 publications

(17 citation statements)

References 38 publications

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“…In Australia, three evidence‐based options for second‐line therapy have been evaluated (Box 2). Levofloxacin‐based triple therapy (PPI, amoxycillin and levofloxacin) has been shown to result in high eradication rates irrespective of the number of prior treatment failures 45 . Quadruple therapy of bismuth subcitrate, a PPI, tetracycline and metronidazole, while clumsy in terms of dosage, is also effective, as metronidazole resistance is overcome by this four‐drug regimen 37 .…”

Section: Prevalence Of Helicobacter Pylori Infection In Australia Andmentioning

confidence: 99%

“…Levofloxacin-based triple therapy (PPI, amoxycillin and levofloxacin) has been shown to result in high eradication rates irrespective of the number of prior treatment failures. 45 Quadruple therapy of bismuth subcitrate, a PPI, tetracycline and metronidazole, while clumsy in terms of dosage, is also effective, as metronidazole resistance is overcome by this fourdrug regimen. 37 Rifabutin-based triple therapy may also be used but is less effective, and the occasional occurrence of neutropenia tends to limit its use.…”

Section: Treatment and Drug Resistancementioning

confidence: 99%

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Epidemiology, clinical impacts and current clinical management of Helicobacter pylori infection

Mitchell

Katelaris

2016

Medical Journal of Australia

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Helicobacter pylori infection is a major cause of morbidity and mortality worldwide. More than 50% of the global population is estimated to be infected. Differences in prevalence exist within and between countries, with higher prevalence seen among people with lower socio-economic status. Most transmission of infection occurs early in life, predominantly from person to person in the family setting. H. pylori is the cause of most peptic ulcer disease, gastric cancer and gastric mucosa-associated lymphoid tissue (MALT) lymphoma and causes symptoms in a subset of patients with functional dyspepsia. Choice of diagnostic test depends on the clinical context; urea breath tests and endoscopy with biopsy are the major diagnostic tools. Evidence-based indications for eradication of H. pylori infection are well documented. The most widely used and recommended eradication therapy in Australia is triple therapy comprising a proton pump inhibitor, amoxycillin and clarithromycin, usually for 1 week. Effective alternative regimens are available for patients with proven allergy to penicillin. Antimicrobial resistance is the major determinant of the outcome of eradication therapy. Trends in antibiotic resistance need to be monitored locally, but individual patient susceptibility testing is not usually necessary as it rarely guides the choice of therapy. The outcome of treatment should be assessed not less than 4 weeks after therapy. This is usually done with a urea breath test if follow-up endoscopy is not required. When first-line therapy fails, several proven second-line therapies may be used. Repeat first-line therapy and ad hoc regimens should be avoided. Overall cumulative eradication rates should approach 99%.

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Section: Prevalence Of Helicobacter Pylori Infection In Australia Andmentioning

confidence: 99%

Section: Treatment and Drug Resistancementioning

confidence: 99%

Epidemiology, clinical impacts and current clinical management of Helicobacter pylori infection

Mitchell

Katelaris

2016

Medical Journal of Australia

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“…However, eradication rates with this regimen vary according to resistance rates which are increasing with its more widespread use. Studies from Australia report relative success with this salvage therapy, with eradication rates of 89%‐91% . A Taiwanese study, however, reported suboptimal eradication rates (69.2%) with triple therapy compared to fluoroquinolone‐based quadruple therapy .…”

Section: Fluoroquinolonesmentioning

confidence: 99%

“…Studies from Australia report relative success with this salvage therapy, with eradication rates of 89%-91%. 31,32 A Taiwanese study, however, reported suboptimal eradication rates (69.2%) with triple therapy compared to fluoroquinolone-based quadruple therapy. 33 A further study from Taiwan demonstrated higher eradication rates with levofloxacinbased concomitant therapy (96.4%) compared to sequential therapy (81.4%).…”

Section: Fluoroquinolone Smentioning

confidence: 99%

Treatment of Helicobacter pylori infection in 2018

et al. 2018

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Treatment options for the eradication of Helicobacter pylori continue to evolve. There have been many guidelines for H. pylori treatment published, which may lead to some confusion. However, most are in agreement with the most recent iteration of the Maastricht treatment guidelines. Triple therapy is still the most frequently used treatment, especially in areas of low clarithromycin resistance. Its best results are achieved when taken for a minimum of 10 days and with high-dose acid suppression. Quadruple therapy is gaining in popularity particularly in areas with increasing resistance to standard triple therapy. Whether three antibiotics, or bismuth and two antibiotics are used, excellent eradication rates are achieved, albeit with increased side effects. Levofloxacin second-line therapy is widely used; however bismuth, when available, is an increasingly successful option. Sequential therapy is challenging in terms of compliance and is no longer recommended. This past year witnessed a notable increase in the number of studies based on antimicrobial susceptibility testing and tailored eradication therapy, reflecting the role of culture-guided treatment, which may well represent the future of H. pylori treatment and prevent the inappropriate use of antibiotics.

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“…A study of levofloxacin used in concomitant therapy compared to standard sequential therapy for patients with type 2 diabetes, often considered to be a difficult‐to‐treat group, reported 96.4% vs 81.4% eradication rates in favor of the levofloxacin arm . Another group in Australia looked at difficult‐to‐treat patients with a median of 2 and up to 7 failed eradication attempts and reported 90% cure for levofloxacin‐based triple therapy . In Egypt, a novel quadruple combination of levofloxacin, nitazoxanide, doxycycline, and omeprazole prescribed for 14 days led to a successful eradication of H. pylori in 83% of patients who had previously failed first‐line therapy …”

Section: Levofloxacin‐ and Other Fluoroquinolone‐based Therapiesmentioning

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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A prospective evaluation of levofloxacin‐based triple therapy for refractory Helicobacter pylori infection in Australia

Abstract: The efficacy and safety of this levofloxacin-based triple therapy suggests it should be used as a salvage regimen in this region. Randomised comparative trials are unlikely to be done but these data compare favourably with local data for other salvage therapies.

Cited by 12 publications

References 38 publications

Epidemiology, clinical impacts and current clinical management of Helicobacter pylori infection

Epidemiology, clinical impacts and current clinical management of Helicobacter pylori infection

Treatment of Helicobacter pylori infection in 2018

Treatment of Helicobacter pylori infection 2017

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