Fourth-generation quinolones in the treatment of Helicobacter pylori infection: A meta-analysis

Abstract

AIMTo assess the efficacy and safety of fourth-generation quinolones for Helicobacter pylori (H. pylori) eradication, we conducted this systematic review and meta-analysis of randomized clinical trials.METHODSMajor literature databases (PubMed, EMBASE and the Cochrane Central Register of Controlled Trials) were searched for relevant articles published prior to February 2018. We performed a meta-analysis of all randomized clinical trials that examined the efficacy of H. pylori eradication therapies and included fourth-generation quinolones in the experimental arm. Subgroup analyses by regions and different types of fourth-generation quinolones were also performed.RESULTSTen studies including a total of 2198 patients were assessed. A meta-analysis of randomized controlled trials showed that the eradication rate of therapies containing non-fourth-generation quinolones was significantly lower than that of therapies containing fourth-generation quinolones by intention-to-treat (ITT) analysis [75.4% vs 81.8%; odds ratio (OR) = 0.661; 95% confidence interval (CI): 0.447-0.977; P = 0.038]. This analysis also showed that the eradication rate of the therapies containing non-fourth-generation quinolones was inferior to that of therapies containing fourth-generation quinolones by per-protocol analysis (79.1% vs 84.7%; OR = 0.663; 95%CI: 0.433-1.016; P = 0.059). Moreover, the occurrence of side effects was significantly different between the control and experimental groups by ITT analysis (30.6% vs 19.5%; OR = 1.874; 95%CI: 1.120-3.137; P = 0.017). The sub-analyses also showed significant differences in moxifloxacin therapies vs other fourth-generation quinolone therapies (84.3% vs 71.9%) and in Asian vs European groups (76.7% vs 89.1%).CONCLUSIONTherapies containing fourth-generation quinolones achieved a poor eradication rate in the treatment of H. pylori infection. Such regimens might be useful as a rescue treatment based on antimicrobial susceptibility testing. Different antibiotics should be chosen in different regions.

Empirical Helicobacter pylori rescue therapy: an 18‐year single‐centre study of 1200 patients

“…In 2013, LEV was replaced by MOX, the dose of PPI was escalated to high‐dose esomeprazole and the duration was prolonged to 14 days. The second‐line eradication rate of the PPI‐MOX‐AMO triple therapy rose to 86%, figure similar to that in a multicentre study that evaluated this treatment in 250 patients and to that seen in a recent meta‐analysis on the use of fourth generation quinolones in Asia and Europe . However, the current cost of a 14 day‐treatment with esomeprazole 40 mg, MOX and AMO in Spain is € 66.26.…”

New insights into resistance of Helicobacter pylori against third‐ and fourth‐generation fluoroquinolones: A molecular docking study of prevalent GyrA mutations

“…In regard to the efficiency of FQs in clinical practice, a systematic review (of 2198 patients, of 10 randomized controlled trials, from 4 Asian and 3 European countries) has reported a higher eradication rate for fourth‐generation (MXN and GXN, 81.8%,) versus non–fourth‐generation (LVX, 75.4%, P = 0.038) FQs. Accordingly, LVX‐resistant H pylori strains in France, remained sensitive to MXN and patients in Italy, were found more responsive to 7‐day moxifloxacin‐based triple therapies than standard treatment .…”

Therapeutic Potential of Sitafloxacin as a New Drug Candidate for Helicobacter Eradication in Korea: An In Vitro Culture-Based Study

“…However, drug-resistant H. pylori strains have evolved to evade attachment from conventional quinolone series drugs though mutations in their gyrA gene [35]. Therefore, since the gyrA gene plays a pivotal role in nucleic acid synthesis, mutations in this gene may result in the resistance of H. pylori to conventional quinolone drugs [10,22,36,37]. Notably, among the various sites of gyrA gene mutations, sitafloxacin especially showed activity at D91, but not at N87.…”