Clinical trial: clarithromycin vs. levofloxacin in first‐line triple and sequential regimens for <i>Helicobacter pylori</i> eradication

Molina–Infante, Javier; Perez-Gallardo, Belen; Fernandez-Bermejo, Miguel; Hernández-Alonso, Moisés; Vinagre, Gemma; Dueñas, Carmen; Mateos-Rodríguez, José María; González-García, Guadalupe; Abadia, Elena Garcia; Gisbert, Javier P.

doi:10.1111/j.1365-2036.2010.04274.x

Cited by 101 publications

(37 citation statements)

References 38 publications

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“…22 However, a recent update of previous meta-analyses performed by a Cochrane Collaboration group23 found that the results obtained with the sequential regimen were clearly heterogeneous, and that several recently published studies were unable to demonstrate differences between sequential and standard triple therapy. So, although the overall mean eradication rate with the sequential regimen was nearly 90%, a tendency towards lower efficacy with this regimen was observed in the more recent studies 24–27…”

Section: Introductionmentioning

confidence: 90%

“…The authors evaluated the efficacy of empiric concomitant therapy in a geographical area (Spain) where sequential therapy had previously proved inefficient (76% cure rate in a prior study24). Eradication rates for the concomitant regimen were 88% by per-protocol analysis and 85% by intention-to-treat analysis, and the authors concluded that in settings with high clarithromycin resistance (>5%–20%) and documented failure of sequential therapy, concomitant therapy may achieve acceptable eradication rates 50.…”

Section: Effects Of Different Variables On the Efficacy Of Concomitanmentioning

confidence: 99%

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Update on non-bismuth quadruple (concomitant) therapy for eradication of Helicobacter pylori

Gisbert¹,

Calvet²

2012

CEG

123

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BackgroundTraditional standard triple therapy for Helicobacter pylori (H. pylori) infection (proton pump inhibitor-clarithromycin-amoxicillin) can easily be converted to non-bismuth quadruple (concomitant) therapy by the addition of a nitroimidazole twice daily.AimTo critically review evidence on the role of non-bismuth quadruple therapy (proton pump inhibitor-clarithromycin-amoxicillin-nitroimidazole) in the treatment of H. pylori infection.MethodsBibliographical searches were performed in MEDLINE and relevant congresses up to December 2011. We performed a meta-analysis of the studies evaluating the concomitant therapy, and of the randomized controlled trials comparing the concomitant and the standard triple therapy.ResultsA meta-analysis of 19 studies (2070 patients) revealed a mean H. pylori cure rate (intention-to-treat) of 88% (95% confidence interval from 85% to 91%) for non-bismuth quadruple therapy. We performed a meta-analysis of the randomized controlled studies comparing the concomitant (481 patients) and the standard triple therapy (503 patients). The former was more effective than the latter: 90% versus 78% (intention-to-treat analysis). Results were homogeneous (I2 = 0%). The odds ratio for this comparison was 2.36 (95% confidence interval from 1.67 to 3.34). A tendency toward better results with longer treatments (7–10 days versus 3–5 days) has been observed, so it seems reasonable to recommend the length of treatment achieving the highest cure rates (10 days). Clarithromycin resistance may reduce the efficacy of non-bismuth quadruple therapy, although the decrease in eradication rates seems to be far lower than in standard triple therapy. Experience with the non-bismuth quadruple therapy in patients with metronidazole-resistant strains is still very limited.ConclusionNon-bismuth quadruple (concomitant) therapy appears to be an effective, safe, and well-tolerated alternative to triple therapy and is less complex than sequential therapy. Therefore, this regimen appears well suited for use in settings where the efficacy of triple therapy is unacceptably low.

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Section: Introductionmentioning

confidence: 90%

Section: Effects Of Different Variables On the Efficacy Of Concomitanmentioning

confidence: 99%

Update on non-bismuth quadruple (concomitant) therapy for eradication of Helicobacter pylori

Gisbert¹,

Calvet²

2012

CEG

123

View full text Add to dashboard Cite

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“…However, the eradication rates achieved with first-line levofloxacin-based treatments are not uniform. Some reports show improved efficacy with levofloxacin-based regimens in comparison to standard first-line therapy, whereas others have found equivalent or poorer responses [9], [11]–[12].…”

Section: Introductionmentioning

confidence: 99%

Levofloxacin-Based First-Line Therapy versus Standard First-Line Therapy for Helicobacter pylori Eradication: Meta-Analysis of Randomized Controlled Trials

2014

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BackgroundFirst-line levofloxacin-based treatments eradicate Helicobacter pylori with varying success. We examined the efficacy and safety of first-line levofloxacin-based treatment in comparison to standard first-line therapy for H pylori eradication.Materials and MethodsWe searched literature databases from Medline, EMBASE, and the Cochrane Register of Randomized Controlled Trials through March 2013 for randomized controlled trials comparing first-line levofloxacin and standard therapy. We included randomized controlled trials conducted only on naïve H pylori infected patients in adults. A systematic review was conducted. Meta-analysis was performed with Review Manager 5.2. Treatment effect was determined by relative risk with a random or fixed model by the Mantel-Haenszel method.ResultsSeven trials were identified with 888 patients receiving 7 days of first-line levofloxacin and 894 treated with standard therapy (Amoxicillin, Clarithromycin and proton pump inhibitor) for 7 days. The overall crude eradication rate in the Levofloxacin group was 79.05% versus 81.4% in the standard group (risk ratio 0.97; 95% CI; 0.93, 1.02). The overall dropout was 46 (5.2%) in the levofloxacin group and 52 (5.8%) for standard therapy. The dizziness was more common among group who took Levofloxacin based treatment and taste disturbance was more common among group who took standard therapy. Meta-analysis of overall adverse events were similar between the two groups with a relative risk of 1.06 (95% CI 0.72, 1.57).Conclusion Helicobacter pylori eradication with 7 days of Levofloxacin-based first line therapy was safe and equal compared to 7 days of standard first-line therapy.

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“…This was much higher than the eradication rate after 10 days of LBT using omeprazole and lansoprazole (72–83%) [13, 15, 16] and was comparable with that of LBT using esomeprazole (87–96%) [17, 18]. This suggests that ilaprazole may have unique properties and better pharmacokinetic and pharmacodynamic profiles compared with other PPIs.…”

Section: Discussionmentioning

confidence: 77%

Efficacy and Safety of the Triple Therapy Containing Ilaprazole, Levofloxacin, and Amoxicillin as First-Line Treatment in Helicobacter pylori Infections

Ahn

Kim

Chu

et al. 2017

Gastroenterology Research and Practice

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Background and Aims. To establish the efficacy and safety of ilaprazole, levofloxacin, and amoxicillin as a first-line eradication treatment for Helicobacter pylori. Methods. Patients with gastric ulcer, duodenal ulcer, or gastritis, as detected by esophagogastroduodenoscopy with confirmed H. pylori infection between September 2014 and November 2015, were enrolled in the study. All participants received ilaprazole (10 mg bid), levofloxacin (500 mg bid), and amoxicillin (1000 mg bid) for 10 days. H. pylori eradication was confirmed by a 13C-urea breath test at 6–8 weeks after the end of treatment. Results. Of 84 patients included in the analysis, the eradication rate was 88.8% in the per protocol group (n = 80). Demographic factors such as age, gender, body mass index (BMI), alcohol, smoking, hypertension, diabetes mellitus, and peptic ulcer did not affect the eradication rate. However, multivariate analysis showed that overweight patients and patients with cerebrovascular accident (CVA) had a significantly lower eradication rate than patients with normal BMI and without CVA. Laboratory test results did not change significantly after treatment. A total of six (7.5%) patients developed eight adverse reactions. Conclusions. A 10-day triple therapy containing ilaprazole, levofloxacin, and amoxicillin is a safe alternative first-line eradication treatment for H. pylori.

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Clinical trial: clarithromycin vs. levofloxacin in first‐line triple and sequential regimens for Helicobacter pylori eradication

Abstract: SUMMARY BackgroundHelicobacter pylori eradication rates with standard triple therapy have declined to unacceptable levels.

Cited by 101 publications

References 38 publications

Update on non-bismuth quadruple (concomitant) therapy for eradication of Helicobacter pylori

Update on non-bismuth quadruple (concomitant) therapy for eradication of Helicobacter pylori

Levofloxacin-Based First-Line Therapy versus Standard First-Line Therapy for Helicobacter pylori Eradication: Meta-Analysis of Randomized Controlled Trials

Efficacy and Safety of the Triple Therapy Containing Ilaprazole, Levofloxacin, and Amoxicillin as First-Line Treatment in Helicobacter pylori Infections

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