Efficacy of 5-Day Levofloxacin-Containing Concomitant Therapy in Eradication of Helicobacter pylori Infection

Federico, Alessandro; Nardone, Gerardo; Gravina, Antonietta Gerarda; Iovene, Maria Rosaria; Miranda, Agnese; Compare, Debora; Pilloni, Paola A.; Rocco, Alba; Ricciardiello, Luigi; Marmo, Riccardo; Loguercio, C.; Romano, Marco

doi:10.1053/j.gastro.2012.03.043

Cited by 83 publications

(79 citation statements)

References 37 publications

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“…This value includes the three patients with concomitant SIBO. All subjects (both rosacea patients and controls) who did not eradicate H. pylori infection were offered a second-line 10-day levofloxacin-containing sequential regimen 16 whereas those patients who did not eradicate SIBO were offered a second-line treatment with metronidazole 250 mg tris in die (t.i.d) for one week. As far as rosacea patients are concerned, both SIBO patients were eradicated of the infection but did not show any improvement in their skin lesions (data not shown).…”

Section: Resultsmentioning

confidence: 99%

Helicobacter pylori infection but not small intestinal bacterial overgrowth may play a pathogenic role in rosacea

Gravina¹,

Federico²,

Ruocco

et al. 2015

UEG Journal

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Background and aims: Recent studies suggest a potential relationship between rosacea and Helicobacter pylori (H. pylori) infection or small intestinal bacterial overgrowth (SIBO), but there is no firm evidence of an association between rosacea and H. pylori infection or SIBO. We performed a prospective study to assess the prevalence of H. pylori infection and/or SIBO in patients with rosacea and evaluated the effect of H. pylori or SIBO eradication on rosacea. Methods: We enrolled 90 patients with rosacea from January 2012 to January 2013 and a control group consisting of 90 patients referred to us because of mapping of nevi during the same period. We used the 13 C Urea Breath Test and H. pylori stool antigen (HpSA) test to assess H. pylori infection and the glucose breath test to assess SIBO. Patients infected by H. pylori were treated with clarithromycin-containing sequential therapy. Patients positive for SIBO were treated with rifaximin. Results: We found that 44/90 (48.9%) patients with rosacea and 24/90 (26.7%) control subjects were infected with H. pylori (p ¼ 0.003). Moreover, 9/90 (10%) patients with rosacea and 7/90 (7.8%) subjects in the control group had SIBO (p ¼ 0.6). Within 10 weeks from the end of antibiotic therapy, the skin lesions of rosacea disappeared or decreased markedly in 35/36 (97.2%) patients after eradication of H. pylori and in 3/8 (37.5%) patients who did not eradicate the infection (p < 0.0001). Rosacea skin lesions decreased markedly in 6/7 (85.7%) after eradication of SIBO whereas of the two patients who did not eradicate SIBO, one (50%) showed an improvement in rosacea (p ¼ 0.284). Conclusions: Prevalence of H. pylori infection was significantly higher in patients with rosacea than control group, whereas SIBO prevalence was comparable between the two groups. Eradication of H. pylori infection led to a significant improvement of skin symptoms in rosacea patients.

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Section: Resultsmentioning

confidence: 99%

Helicobacter pylori infection but not small intestinal bacterial overgrowth may play a pathogenic role in rosacea

Gravina¹,

Federico²,

Ruocco

et al. 2015

UEG Journal

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“…A total of 11 RCTs (14-24) were selected based on the inclusion criteria and subjected to a further examination. We excluded one study (24) because the authors used levofloxacin rather than clarithromycin as concomitant therapy. Therefore, 10 RCTs (14-23) with 3,501 patients were included in the meta-analysis.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Recently, several studies have examined the efficacy of these therapies for H. pylori eradication (14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24). However, there is currently no consensus regarding the optimal strategy.…”

Section: Introductionmentioning

confidence: 99%

Meta-Analysis of Sequential, Concomitant and Hybrid Therapy for <i>Helicobacter pylori</i> Eradication

Deng

Luo

2015

Intern. Med.

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Objective To compare the efficacy of sequential therapy, concomitant therapy and hybrid therapy for the treatment of Helicobacter pylori (H. pylori) infection. Methods PubMed, Web of Science, Medline, Embase, the Cochrane Central Register of Controlled Trials and CNKI were searched up to the end of May 10, 2014 in order to identify all randomized controlled trials (RCTs) reporting the effects of sequential therapy, concomitant therapy and hybrid therapy on H. pylori eradication. The relative risk (RR) of eradicating H. pylori infection after sequential therapy compared with concomitant therapy or hybrid therapy was pooled. The eradication rates were considered both on an intention-to-treat (ITT) and per-protocol (PP) basis. Results A total of 10 RCTs involving 3,501 patients were included. The pooled data suggested that the differences between the three groups were not statistically significant (ITT analysis: sequential therapy vs. concomitant therapy: RR=1.01, 95%confidence interval (CI): 0.97-1.04, sequential therapy vs. hybrid therapy: RR=1.02, 95%CI: 0.85-1.22, concomitant therapy vs. hybrid therapy: RR=1.03, 95%CI: 0.97-1.08; PP analysis: sequential therapy vs. concomitant therapy: RR=1.00, 95%CI: 0.96-1.03, sequential therapy vs. hybrid therapy: RR=0.97, 95%CI: 0.86-1.09, concomitant therapy vs. hybrid therapy: RR=1.01, 95%CI: 0.93-1.10). In the ITT and PP analyses, the overall eradication rates were 84.3% (95%CI: 79.1-89.4) and 86.4% (95%CI: 81.7-91.0) for the sequential therapy group, 86.7% (95%CI: 81.0-92.3) and 89.8% (95%CI: 85.1-94.5) for the concomitant therapy group and 86.6% (95%CI: 82.3-91.0) and 92.7% (95%CI: 90.5-94.9) for the hybrid therapy group, respectively. There were no significant differences among these therapies in terms of the rate of side effects. Conclusion The pooled evidence suggests that sequential therapy, concomitant therapy and hybrid therapy are similar with respect to the treatment of H. pylori infection.

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“…Due to this unfavorable outcome, many gastroenterologists have looked for alternative antimicrobial agents, such as fluoroquinolone. Fluoroquinolone-containing eradication regimens have demonstrated favorable results in several countries (26). However, the increase in fluoroquinolone resistance has become a significant limitation for providing effective H. pylori eradication.…”

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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Efficacy of 5-Day Levofloxacin-Containing Concomitant Therapy in Eradication of Helicobacter pylori Infection

Cited by 83 publications

References 37 publications

Helicobacter pylori infection but not small intestinal bacterial overgrowth may play a pathogenic role in rosacea

Helicobacter pylori infection but not small intestinal bacterial overgrowth may play a pathogenic role in rosacea

Meta-Analysis of Sequential, Concomitant and Hybrid Therapy for <i>Helicobacter pylori</i> Eradication

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

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