Eradication Rate by Duration of Third-line Rescue Therapy with Levofloxacin after<i>Helicobacter pylori</i>Treatment Failure in Clinical Practice

Noh, Hyung Min; Hong, Su Jin; Han, Jae Pil; Park, Kyung Woo; Lee, Yun Nah; Lee, Tae Hee; Ko, Bong Min; Lee, Joon Seong; Lee, Moon Sung

doi:10.4166/kjg.2016.68.5.260

Cited by 13 publications

(12 citation statements)

References 38 publications

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“…In one study, eradication rates were noted of 58.3% for 7-day therapy, 68.2% for 10-day therapy, and 93.3% for 14-day therapy. 43 In a separate study though no significant difference was noted between different treatment durations with the best rates seen for 7-day therapy at 80.6% compared to 64% for 10 days and 68.8% for 14 days. 44 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.…”

Section: Sequential Concomitant and Hybrid Therapymentioning

confidence: 85%

“…As a third‐line treatment, extended courses of levofloxacin‐based therapies were examined in two separate studies from Korea which yielded divergent results. In one study, eradication rates were noted of 58.3% for 7‐day therapy, 68.2% for 10‐day therapy, and 93.3% for 14‐day therapy . In a separate study though no significant difference was noted between different treatment durations with the best rates seen for 7‐day therapy at 80.6% compared to 64% for 10 days and 68.8% for 14 days .…”

Section: Levofloxacin‐ and Other Fluoroquinolone‐based Therapiesmentioning

confidence: 95%

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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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Section: Sequential Concomitant and Hybrid Therapymentioning

confidence: 85%

Section: Levofloxacin‐ and Other Fluoroquinolone‐based Therapiesmentioning

confidence: 95%

Treatment of Helicobacter pylori infection 2017

et al. 2017

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“…Regarding the optimal duration for H. pylori eradication therapy, a meta-analysis showed that increasing the duration of PPI-based triple therapy increased the eradication rates [ 45 ]. There are many reports that the eradication rates of fluoroquinolone-based therapy were increased by extending the duration to 14 days [ 46 , 47 , 48 , 49 , 50 , 51 , 52 ]. Conversely, Furura et al compared 7-day and 14-days regimens of PPI–sitafloxacin–amoxicillin in their RCT, and found no significant difference.…”

Section: Discussionmentioning

confidence: 99%

Sitafloxacin for Third-Line Helicobacter pylori Eradication: A Systematic Review

Nishizawa

Munkjargal

Ebinuma

et al. 2021

JCM

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Background and Aim: Sitafloxacin-based therapy is a potent candidate for third-line Helicobacter pylori eradication treatment. In this systematic review, we summarise current reports with sitafloxacin-based therapy as a third-line treatment. Methods: Clinical studies were systematically searched using PubMed, Cochrane library, Web of Science, and the Igaku-Chuo-Zasshi database. We combined data from clinical studies using a random-effects model and calculated pooled event rates, 95% confidence intervals (CIs), and the pooled odds ratio (OR). Results: We included twelve clinical studies in the present systematic review. The mean eradication rate for 7-day regimens of either PPI (proton pump inhibitor) or vonoprazan–sitafloxacin–amoxicillin was 80.6% (95% CI, 75.2–85.0). The vonoprazan–sitafloxacin–amoxicillin regimen was significantly superior to the PPI–sitafloxacin–amoxicillin regimen (pooled OR of successful eradication: 6.00; 95% CI: 2.25–15.98, p < 0.001). The PPI–sitafloxacin–amoxicillin regimen was comparable with PPI–sitafloxacin–metronidazole regimens (pooled OR: 1.06; 95% CI: 0.55–2.07, p = 0.86). Conclusions: Although the 7-day regimen composed of vonoprazan, sitafloxacin, and amoxicillin is a good option as the third-line Helicobacter pylori eradication treatment in Japan, the extension of treatment duration should be considered to further improve the eradication rate. Considering the safety concern of fluoroquinolones, sitafloxcin should be used after confirming drug susceptibility.

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“…The possible factors include microorganism-related factors (high bacterial load and biofilm of H. pylori ), host-related factors (poor compliance to eradication regimen, smoking, cytochrome P450 2C19 genetic polymorphism, and impaired mucosal immunity), or treatment-related factors (inadequate dosage or duration of therapy and gastric acidity) [ 22 , 27 , 28 ]. Poor adherence was reemphasized as an important cause of eradication failure after 1st-line and 2nd-line treatments [ 29 ], and extending the duration of quinolone-containing rescue therapy showed increasing eradication rate in a recent study [ 30 ]. Infection with multiple strains other than H. pylori is another possible reason [ 31 , 32 ]; more than 2 strains were cultured in 65% of patients, and the antibiotic susceptibility profile among the different strains was consistent only in 61.1% of patients in a Korean study [ 32 ].…”

Section: Unsolved Issuesmentioning

confidence: 99%

Current Status of the Third-LineHelicobacter pyloriEradication

Choi

Bang

Lee

et al. 2018

Gastroenterology Research and Practice

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Antibiotic resistance is growing worldwide, and patients who have failed consecutive 1st- and 2nd-line H. pylori eradication regimens are increasing. Therefore, the role of the bacterial culture with antibiotic susceptibility testing and molecular susceptibility testing is important for avoiding the use of ineffective antibiotics. However, antibiotic susceptibility testing-guided treatment does not necessarily guarantee successful eradication, and there have been mixed results for the effectiveness of a 3rd-line rescue therapy. Therefore, providing patients with pretreatment medication instructions and education is important. It is also crucial to determine the reason of the eradication failure, including host-related factors (poor compliance to eradication regimen, smoking, and cytochrome P450 2C19 genetic polymorphism) or treatment-related factors (inadequate dosage or duration of therapy and gastric acidity), as such factors can be modified for a tailored therapy. Although the indications for H. pylori eradication have widened, patients at a high risk of gastric cancer can gain definitive benefits with a 3rd-line or even 4th-line therapy.

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Eradication Rate by Duration of Third-line Rescue Therapy with Levofloxacin afterHelicobacter pyloriTreatment Failure in Clinical Practice

Abstract: This study showed somewhat increasing of eradication rate by extending the duration of levofloxacin-containing rescue therapy to 14 days.

Cited by 13 publications

References 38 publications

Treatment of Helicobacter pylori infection 2017

Treatment of Helicobacter pylori infection 2017

Sitafloxacin for Third-Line Helicobacter pylori Eradication: A Systematic Review

Current Status of the Third-LineHelicobacter pyloriEradication

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