Efficacy of Levofloxacin-Based Third-Line Therapy for the Eradication of <i>Helicobacter pylori</i> in Peptic Ulcer Disease

Lim, Joo Hyun; Kim, Sang Gyun; Song, Ji Hyun; Hwang, Jae Chul; Lee, Dong Hoon; Han, Jae Pil; Hong, Su Jin; Kim, Ji Hyun; Kim, Gwang Ha; Shim, Ki Nam; Shin, Woon Geon; Kim, Tae Ho; Kim, Sun Moon; Chung, Il Kwon; Kim, Hyun Soo; Kim, Heung Up; Lee, Joongyub; Kim, Jae Gyu

doi:10.5009/gnl16099

Cited by 19 publications

(13 citation statements)

References 33 publications

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“…Levofloxacin triple regimen or rifabutin triple regimen is suggested as rescue therapy by the guidelines [ 6 , 18 ]. However, Lim et al reported in 2017 that the eradication rate of levofloxacin triple regimen as third-line treatment was 56.9% in Korea [ 37 ]. This low eradication rate can be explained by the high-resistance rate to levofloxacin in Korea [ 28 , 38 ].…”

Section: Discussionmentioning

confidence: 99%

Role of Antimicrobial Susceptibility Testing before First-Line Treatment Containing Clarithromycin for Helicobacter pylori Eradication in the Clinical Setting

et al. 2021

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Background: Checking Helicobacter pylori susceptibility tests in the clinical setting before first-line treatment is considered difficult. We compared susceptibility-guided therapy (SGT) with empirical therapy (ET) as a first-line treatment containing clarithromycin and investigated the eradication rate using antimicrobial susceptibility testing (AST). Methods: 257 patients with H. pylori infection, with AST, performed before the eradication of clarithromycin-containing regimens were enrolled and divided into two groups: the SGT and ET groups. Results: Eradication rates in the SGT and ET groups were 85.4% and 58.4% (P < 0.01), respectively. In triple therapy (TT), eradication rates of the SGT and ET groups were 85.1% and 56.6% (P < 0.01), respectively. In sequential therapy (SET), eradication rates of the SGT and ET groups were 86.2% and 65.6% (P = 0.06), respectively. According to AST, TT had an eradication rate of 84.6% with strains susceptible to clarithromycin and amoxicillin and 11.1% with strains resistant to both. SET had an eradication rate of 89.5% with strains susceptible to clarithromycin, amoxicillin, and metronidazole, whereas it was 0% with strains resistant to clarithromycin and metronidazole. Conclusions: SGT as first-line treatment improved eradication rates of TT and SET by 28.5 (P < 0.01) and 20.6 (P = 0.06) percent points, respectively, compared with ET.

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Section: Discussionmentioning

confidence: 99%

Role of Antimicrobial Susceptibility Testing before First-Line Treatment Containing Clarithromycin for Helicobacter pylori Eradication in the Clinical Setting

et al. 2021

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“…This regimen is also recommended as a secondary therapeutic option after failure of 1st-line eradication therapy [6,15]. The efficacy of levofloxacin-based triple therapy as first line treatment was reported as 52.5-65.3%, while the efficacy as third line treatment was 71.6% in Korea [16][17][18]. According to this result, levofloxacin-based regimen seems to be a possible option for rescue therapy.…”

Section: Discussionmentioning

confidence: 99%

Discovery of a Novel Mutation in DNA Gyrase and Changes in the Fluoroquinolone Resistance of Helicobacter pylori over a 14-Year Period: A Single Center Study in Korea

Rhie

Park

Shin³

et al. 2020

Antibiotics

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The efficacy of fluoroquinolone-based eradication therapy largely depends on the fluoroquinolone resistance of H. pylori. The aim of this study was to investigate the changes in the primary resistance rate of H. pylori to fluoroquinolone and the mechanism of resistance in Korea. A total of 153 strains and 48 strains of H. pylori were isolated at a tertiary hospital in 2005/2006 and 2017/2018, respectively. The minimum inhibitory concentrations (MICs) of fluoroquinolone were determined by the serial 2-fold agar dilution method. DNA sequences in the quinolone resistance-determining regions of gyrA/gyrB were analyzed in resistant strains. Subsequent natural transformation study was performed to determine the association between gyrase mutation and resistance. The resistance rates increased from 19.0% (29/153) to 43.8% (21/48) both for levofloxacin and moxifloxacin. The MIC values for resistant strains increased from 2–8 µg/mL to 4–16 µg/mL over time. Mutation of gyrA was detected in 93.1% (27/29) and 100% (21/21) among the resistant strains in both periods, respectively. A novel Gly-85 mutation of gyrA was found and confirmed to be associated with fluoroquinolone resistance. Fluoroquinolone resistance rate of H. pylori has markedly increased over time in Korea. The resistance is mostly due to the point mutation of gyrA. Fluoroquinolone-containing regimens should be carefully selected in Korea, considering the increasing fluoroquinolone resistance.

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“…The addition of ofloxacin to standard triple therapy has been shown to augment eradication rates, while gemifloxacin was inferior to clarithromycin‐based therapies . A review of levofloxacin‐based third‐line therapy over the past decade in Korea found pooled eradication rates of 71.6% throughout the decade, suggesting no increase in resistance rates over the past decade . A 10‐day triple therapy containing ilaprazole, levofloxacin, and amoxicillin reported good results, with an eradication rate of 88.8% …”

Section: Fluoroquinolonesmentioning

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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Efficacy of Levofloxacin-Based Third-Line Therapy for the Eradication of Helicobacter pylori in Peptic Ulcer Disease

Cited by 19 publications

References 33 publications

Role of Antimicrobial Susceptibility Testing before First-Line Treatment Containing Clarithromycin for Helicobacter pylori Eradication in the Clinical Setting

Role of Antimicrobial Susceptibility Testing before First-Line Treatment Containing Clarithromycin for Helicobacter pylori Eradication in the Clinical Setting

Discovery of a Novel Mutation in DNA Gyrase and Changes in the Fluoroquinolone Resistance of Helicobacter pylori over a 14-Year Period: A Single Center Study in Korea

Treatment of Helicobacter pylori infection in 2018

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