Levofloxacin/amoxicillin-based schemes<i>vs</i>quadruple therapy for<i>Helicobacter pylori</i>eradication in second-line

Di, Simona; Fini, Lucia; Daoud, Yayha; Grizzi, Fabio; Gasbarrini, Antonio; Lorenzo, Antonino De; Renzo, Laura Di; McCartney, Sara; Bloom, Stuart

doi:10.3748/wjg.v18.i40.5669

Cited by 52 publications

(27 citation statements)

References 72 publications

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“…Previously it has been reported that the eradication rate of 10-day PAL regimen was higher than that of 7-day PAL regimen 30. However, current study did not show any difference in eradication rates according to treatment duration.…”

Section: Discussioncontrasting

confidence: 82%

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

et al. 2017

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Background/AimsThe resistance rate of Helicobacter pylori is gradually increasing. We aimed to evaluate the efficacy of levofloxacin-based third-line H. pylori eradication in peptic ulcer disease.MethodsBetween 2002 and 2014, 110 patients in 14 medical centers received levofloxacin-based third-line H. pylori eradication therapy for peptic ulcer disease. Of these, 88 were included in the study; 21 were excluded because of lack of follow-up and one was excluded for poor compliance. Their eradication rates, treatment regimens and durations, and types of peptic ulcers were analyzed.ResultsThe overall eradiation rate was 71.6%. The adherence rate was 80.0%. All except one received a proton-pump inhibitor, amoxicillin, and levofloxacin. One received a proton-pump inhibitor, amoxicillin, levofloxacin, and clarithromycin, and the eradication was successful. Thirty-one were administered the therapy for 7 days, 25 for 10 days, and 32 for 14 days. No significant differences were observed in the eradication rates between the three groups (7-days, 80.6% vs 10-days, 64.0% vs 14-days, 68.8%, p=0.353). Additionally, no differences were found in the eradiation rates according to the type of peptic ulcer (gastric ulcer, 73.2% vs duodenal/gastroduodenal ulcer, 68.8%, p=0.655).ConclusionsLevofloxacin-based third-line H. pylori eradication showed efficacy similar to that of previously reported first/second-line therapies.

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Section: Discussioncontrasting

confidence: 82%

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

et al. 2017

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“…All the included studies were published between 2002 and 2015 in English, with the exception of three studies, which were published in Chinese [ 24 – 26 ]. Six studies exclusively evaluated second-line treatment for patients with at least one prior course of treatment failure [ 27 – 32 ]; 12 studies focused on treatment naive patients [ 25 , 26 , 33 – 42 ]; the remaining systematic reviews included RCTs for both first-line and second-line treatment. 13 studies evaluated treatments in patients with comorbid gastric diseases including peptic ulcer disease, duodenal ulcer, functional dyspepsia, chronic gastritis or other non-ulcer diseases [ 24 , 27 , 37 – 40 , 43 – 49 ] (the remaining studies did not provide such data).…”

Section: Resultsmentioning

confidence: 99%

“…Nine studies compared the effectiveness, adverse events rate and therapy discontinuation rates between triple therapy and bismuth-based therapy [ 27 – 32 , 38 , 39 , 50 ]. The study characteristics are presented in Table 4 .…”

Section: Resultsmentioning

confidence: 99%

“…The study characteristics are presented in Table 4 . For the bismuth-based therapies, seven studies evaluated bismuth-based quadruple therapy [ 29 – 32 , 38 , 39 , 50 ], one evaluated ranitidine bismuth citrate (RBC) [ 27 ] and another one evaluated both quadruple therapy and RBC [ 28 ]. Overall, the quadruple therapy was associated with similar or greater eradication rate than standard triple therapy; however when levofloxacin or moxifloxacin was contained in the triple therapy, the reverse was observed.…”

Section: Resultsmentioning

confidence: 99%

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Pharmacological regimens for eradication of Helicobacter pylori: an overview of systematic reviews and network meta-analysis

et al. 2016

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BackgroundApproximately half of the world’s population is infected with Helicobacter pylori (H.pylori), a bacterium shown to be linked with a series of gastrointestinal diseases. A growing number of systematic reviews (SRs) have been published comparing the effectiveness of different treatments for H.pylori infection but have not reached a consistent conclusion. The objective of this study is to provide an overview of SRs of pharmacological therapies for the eradication of H.pylori.MethodsMajor electronic databases were searched to identify relevant SRs published between 2002 and February 2016. Studies were considered eligible if they included RCTs comparing different pharmacological regimens for treating patients diagnosed as H.pylori infected and pooled the eradication rates in a meta-analysis. A modified version of the ‘A Measurement Tool to Assess Systematic Reviews’ (AMSTAR) was used to assess the methodological quality. A Bayesian random effects network meta-analysis (NMA) was conducted to compare the different proton pump inhibitors (PPI) within triple therapy.Results30 SRs with pairwise meta-analysis were included. In triple therapy, the NMA ranked the esomeprazole to be the most effective PPI, followed by rabeprazole, while no difference was observed among the three old generations of PPI for the eradication of H.pylori. When comparing triple and bismuth-based therapy, the relative effectiveness appeared to be dependent on the choice of antibiotics within the triple therapy; moxifloxacin or levofloxacin-based triple therapy were both associated with greater effectiveness than bismuth-based therapy as a second-line treatment, while bismuth-based therapy achieved similar or greater eradication rate compared to clarithromycin-based therapy. Inconsistent findings were reported regarding the use of levofloxacin/moxifloxacin in the first-line treatment; this could be due to the varied resistant rate to different antibiotics across regions and populations. Critical appraisal showed a low-moderate level of overall methodological quality of included studies.ConclusionsOur analysis suggests that the new generation of PPIs and use of moxifloxacin or levofloxacin within triple therapy as second-line treatment were associated with greater effectiveness. Given the varied antibiotic resistant rate across regions, the appropriateness of pooling results together in meta-analysis should be carefully considered and the recommendation of the choice of antibiotics should be localized.Electronic supplementary materialThe online version of this article (doi:10.1186/s12876-016-0491-7) contains supplementary material, which is available to authorized users.

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“…This finding is hardly surprising, as diarrhea and nausea are expected adverse effects for levofloxacin 31 , as well as for amoxicillin 32 , but they did not cause severe discomfort to patients. However, Di Caro et al, when comparing the adverse effects of similar treatments with quadruple therapy, reported a much lower prevalence 33 of adverse effects.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of levofloxacin, amoxicillin and a proton pump inhibitor in the eradication of Helicobacter pylori in Brazilian patients with peptic ulcers

Silva¹,

Queiroz²,

Navarro–Rodriguez³

et al. 2015

Clinics

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OBJECTIVES:The eradication of Helicobacter (H.) pylori allows peptic ulcers in patients infected with the bacteria to be cured. Treatment with the classic triple regimen (proton pump inhibitor, amoxicillin and clarithromycin) has shown decreased efficacy due to increased bacterial resistance to clarithromycin. In our country, the eradication rate by intention to treat with this regimen is 83%. In Brazil, a commercially available regimen for bacterial eradication that uses levofloxacin and amoxicillin with lansoprazole is available; however, its efficacy is not known. Considering that such a treatment may be an alternative to the classic regimen, we aimed to verify its efficacy in H. pylori eradication.METHODS:Patients with peptic ulcer disease infected with H. pylori who had not received prior treatment were treated with the following regimen: 30 mg lansoprazole bid, 1,000 mg amoxicillin bid and 500 mg levofloxacin, once a day for 7 days.RESULTS:A total of 66 patients were evaluated. The patients’ mean age was 52 years, and women comprised 55% of the sample. Duodenal ulcers were present in 50% of cases, and gastric ulcers were present in 30%. The eradication rate was 74% per protocol and 73% by intention to treat. Adverse effects were reported by 49 patients (74%) and were mild to moderate, with a prevalence of diarrhea complaints.CONCLUSIONS:Triple therapy comprising lansoprazole, amoxicillin and levofloxacin for 7 days for the eradication of H. pylori in Brazilian peptic ulcer patients showed a lower efficacy than that of the classic triple regimen.

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Levofloxacin/amoxicillin-based schemesvsquadruple therapy forHelicobacter pylorieradication in second-line

Cited by 52 publications

References 72 publications

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

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

Pharmacological regimens for eradication of Helicobacter pylori: an overview of systematic reviews and network meta-analysis

Efficacy of levofloxacin, amoxicillin and a proton pump inhibitor in the eradication of Helicobacter pylori in Brazilian patients with peptic ulcers

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