Clinical trial: levofloxacin‐based quadruple therapy was inferior to traditional quadruple therapy in the treatment of resistant <i>Helicobacter pylori</i> infection

Yee, Y. K.; Cheung, Ting Kin; Chu, Kent‐Man; Chan, Chi Kuen; Chan, Pierre; But, David; Hung, Ivan Fan-Ngai; Chan, Annie On‐On; Yuen, Man‐Fung; Hsu, Axel; Wong, Bcy

doi:10.1111/j.1365-2036.2007.03452.x

Cited by 25 publications

(15 citation statements)

References 20 publications

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“…Below we offer our hypotheses to explain these different results based on the prevalence of resistance, the doses of metronidazole commonly used, issues with compliance and duration of therapy. One small study of levofloxacin triple therapy plus bismuth from Taiwan was complicated by a high prevalence of amoxicillin resistance46 and another from Hong Kong by multiple prior therapies 47…”

Section: Prior Experience With Triple Therapy Plus Bismuth Therapymentioning

confidence: 99%

Role of bismuth in improvingHelicobacter pylorieradication with triple therapy

Dore

Lü

Graham

2016

Gut

223

248

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In most regions of the world, antimicrobial resistance has increased to the point where empirical standard triple therapy for Helicobacter pylorieradication is no longer recommended. The treatment outcome in a population is calculated as the sum of the treatment success in the subpopulation with susceptible infections plus treatment success in the subpopulation with resistant infections. The addition of bismuth (i.e., 14-day triple therapy plus bismuth) can improve cure rates despite a high prevalence of antimicrobial resistance. The major bismuth effect is to add an additional 30%-40% to the success with resistant infections. The overall result is therefore dependent on the prevalence of resistance and the treatment success in the subpopulation with resistant infections (eg, with proton-pump inhibitor-amoxicillin dual therapy). Here, we explore the contribution of each component and the mechanisms of how bismuth might enhance the effectiveness of triple therapy. We also discuss the limitations of this approach and provide suggestions how triple therapy plus bismuth might be further improved.

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Section: Prior Experience With Triple Therapy Plus Bismuth Therapymentioning

confidence: 99%

Role of bismuth in improvingHelicobacter pylorieradication with triple therapy

Dore

Lü

Graham

2016

Gut

223

248

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“…In a study from Hong Kong, levofloxacin-containing bismuth quadruple therapy was inferior to standard bismuth quadruple therapy in the treatment of resistant H. pylori infection (ITT eradication rates of 73 and 88% and PP eradication rates of 78 and 94%, respectively, p = 0.030). For those with a previous history of levofloxacin triple therapy, the eradication rates were 71 and 93%, respectively (p = 0.139) [16].…”

Section: Discussionmentioning

confidence: 99%

“…Some studies showed the efficacy of 1-week bismuth-and levofloxacin-containing quadruple therapies for first-line therapy. However, in other studies the ineffectiveness of these treatment regimens as second-line therapy were pointed out [16,17].…”

Section: Introductionmentioning

confidence: 99%

“…Furthermore, there are studies showing levofloxacin-containing triple therapy as an effective first-line treatment [14,15]. There are controversial data in comparing the efficacy and duration of bismuth-containing quadruple therapies and levofloxacin-containing triple therapies [16,17]. Some studies showed the efficacy of 1-week bismuth-and levofloxacin-containing quadruple therapies for first-line therapy.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of Helicobacter pylori Eradication Rates of 2-Week Levofloxacin-Containing Triple Therapy, Levofloxacin-Containing Bismuth Quadruple Therapy, and Standard Bismuth Quadruple Therapy as a First-Line Regimen

et al. 2017

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i.d, levofloxacin 500 mg, once daily). The primary outcome was the eradication rate in the intention-to-treat (ITT) and per protocol (PP) analysis. Results: The eradication rates of the above 3 groups using ITT analysis were RBAL 83.8%, RBMT 88.3%, and RAL 74.8% compared with 91.2, 92.5, and 79.2%, respectively, using PP analysis. The eradication rate using RBMT was significantly higher than that of RAL (p = 0.029 in ITT analysis and p = 0.017 in PP analysis). Several side effects occurred in 156 patients (54.1%) KeywordsHelicobacter pylori infection · Bismuth-containing quadruple therapy · Levofloxacin-containing triple therapy · Eradication rate Abstract Objective: The aim of this study was to compare the efficacy and safety of 2-week levofloxacin-containing triple therapy, levofloxacin-containing bismuth quadruple therapy, and standard bismuth-containing quadruple therapy as a firstline regimen for the eradication of Helicobacter pylori. Methods: A total of 329 patients with H. pylori infection were randomly divided into 3 groups to receive one of the following regimens: (a) levofloxacin-containing bismuth quadruple Significance of the Study• This study compared the efficacy of 3 Helicobacter pylori eradication regimens, 2 of which contained levofloxacin, as the first line of treatment. Both quadruple regimens (standard bismuth quadruple therapy or levofloxacin-containing bismuth quadruple therapy) were highly effective in eradicating the infection and significantly superior to levofloxacin-containing triple therapy. Quadruple therapies should be used as first-line therapy for H. pylori infection.

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“…A cultureguided third-line quadruple regimen including omeprazole, bismuth, doxycycline and amoxicillin was effective in 91% even in subjects with resistance to multiple antibiotics [Cammarota et al 2004]. Quadruple therapy with esomeprazole, bismuth, amoxicillin, and levofloxacin was inferior to the recommended second-line quadruple therapy with the combination of PPI, bismuth, tetracycline and metronidazole in a controlled study with an intention-to-treat eradication rate of 56% versus 90%, respectively [Yee et al 2007]. In patients who failed PPI-based first-line triple therapy containing clarithromycin and metronidazole, second-line quadruple therapy according to the Maastricht consensus containing metronidazole and tetracycline was ineffective with eradication rates of only 39%.…”

Section: Pharmacodynamic Effectsmentioning

confidence: 97%

Review: Eradication of H. pylori infection: the challenge is on if standard therapy fails

Bohr

Malfertheiner

2009

Therap Adv Gastroenterol

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The recommended standard triple therapy for Helicobacter pylori infection, consisting of a proton pump inhibitor, clarithromycin and amoxicillin or metronidazole, can reach eradication rates in over 90%. However, in recent years resistance to antibiotics has increased and eradication rates have declined. Approximately one in five patients need a second-line therapy because eradication therapy fails. Second-line treatment with a bismuth-based quadruple therapy leads to satisfactory eradication rates, but bismuth is not available in many countries. Modern second-and third-line treatments can only be successful if they are adapted to the current resistance situation and they need to evolve continuously. Moreover, pharmacodynamic effects due to polymorphisms of the cytochrome P450 system are important. Because therapy adherence is significantly associated with therapy success, modern regimens if possible should be easy to take and well tolerated. In recent years, various novel salvage-therapy regimens have been investigated that significantly improve treatment options.

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Clinical trial: levofloxacin‐based quadruple therapy was inferior to traditional quadruple therapy in the treatment of resistant Helicobacter pylori infection

Abstract: SUMMARY BackgroundThe efficacy of levofloxacin-based quadruple therapy in resistant Helicobacter pylori infection is not known.

Cited by 25 publications

References 20 publications

Role of bismuth in improvingHelicobacter pylorieradication with triple therapy

Role of bismuth in improvingHelicobacter pylorieradication with triple therapy

Comparison of Helicobacter pylori Eradication Rates of 2-Week Levofloxacin-Containing Triple Therapy, Levofloxacin-Containing Bismuth Quadruple Therapy, and Standard Bismuth Quadruple Therapy as a First-Line Regimen

Review: Eradication of H. pylori infection: the challenge is on if standard therapy fails

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