Levofloxacin and proton pump inhibitor‐based triple therapy versus standard triple first‐line therapy for <scp><i>Helicobacter pylori</i></scp> eradication

Ye, Chenli; Liao, Guoping; He, Shuai; Pan, Ya-min; Kang, Yingbo; Zhang, Zhongyi

doi:10.1002/pds.3581

Cited by 18 publications

(19 citation statements)

References 67 publications

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“…A difference was noted related to different geographic areas with 7‐day standard triple regimen being statistically superior to 7‐day levofloxacin‐based scheme in the Asian group (RR = 0.91, 95% CI = 0.86–0.97), but levofloxacin‐based triple therapy was superior regardless of treatment time in European countries (RR = 1.15, 95% CI = 1.06–1.23) with no difference observed regarding side effects . A further systematic review reported the pooled OR by ITT for the levofloxacin triple regimen versus standard regimen was 1.28 (95% CI: 0.88–1.85) . Two other original studies also compared fluoroquinolone‐based triple therapy to standard triple therapy.…”

Section: Fluoroquinolonesmentioning

confidence: 99%

Treatment of Helicobacter pylori Infection 2015

et al. 2015

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Many interesting articles have been published from many parts of the world over the last year assessing different issues around Helicobacter pylori eradication therapy. This article will address the published literature over the last year pertaining to the topic of treatment of H. pylori infection. The main themes that emerge are assessing the efficacy of standard triple therapy, as well as exploring new first-line treatments, mainly optimized nonbismuthand bismuth-containing quadruple therapies with some promising data also emerging on dual therapy. There was also considerable progress in investigating antibiotic resistance rates with much more data emerging from varied parts of the world compared to recent years. There have also been advances in the use of adjunctive therapies, especially probiotic therapies. Undoubtedly, the eradication of H. pylori remains a worthwhile goal to alleviate the burden of diseases caused by the complications of this infection, including dyspepsia, peptic ulcer disease, and gastric cancer. Triple TherapyA number of studies have been published this year, primarily from Asia, on standard triple therapy which remains the regimen recommended in the majority of published guidelines. A meta-analysis from China showed suboptimal eradication rates in this part of the world with a pooled rate of 74.5% which was inferior when compared to sequential therapy with relative risk (RR) = 0.863 [1]. Better, but still insufficient, eradication rates however were noted in Korea, with an overall eradication rate of 84% from 2005 to 2010 [2]. In Japan, while rates remain clearly suboptimal, eradication rates by per-protocol (PP) analysis have not changed between 2001 and 2010 although there has been a decline in eradication rates by intention-to-treat (ITT) analysis [3]. Another Japanese group from a region of higher clarithromycin resistance compared 7-day standard triple therapy with rabeprazole, amoxicillin, and clarithromycin (RAC) to rabeprazole, amoxicillin, and metronidazole (RAM). They found ITT eradication rates of 73% in the RAC group and 91% in the RAM group [4]. In other regions, a study in Nigeria found an eradication rate of 87% for triple therapy with no difference between 7 and 10 days of treatment [5]. An interesting study from Spain showed that when clarithromycin susceptibility testing is carried out prior to treatment, eradication rates reach 94% compared to 72% for empiric treatment, based on a 10-day regimen [6]. Similar findings emerged from a Japanese study where 97% eradication was achieved when antimicrobial susceptibility testing was carried out prior to treatment, and it was 95% eradication in a Korean study [7,8]. Another study from Spain examined the optimal first-line eradication regimen for patients with penicillin allergy and reported ITT eradication rates with omeprazole-clarithromycin-metronidazole of only 57% compared to 74% for PPI-bismuth-tetracyclinemetronidazole, with equivalent rates of compliance and adverse events. In this specific group for second-line treat...

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Section: Fluoroquinolonesmentioning

confidence: 99%

Treatment of Helicobacter pylori Infection 2015

et al. 2015

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“…17 Additionally, levofloxacin is an effective alternative to current standard antibiotics and tackles the primary resistance to macrolides and nitroimidazoles. 18 Therefore several studies also recommended a levofloxacin based triple treatment, containing a proton pump inhibitor, levofloxacin, and one antibiotic. 18 Previous studies reported that adding probiotics improved the effectiveness of H pylori eradication during standard triple treatment in some circumstances.…”

Section: Introductionmentioning

confidence: 99%

Comparative effectiveness and tolerance of treatments forHelicobacter pylori: systematic review and network meta-analysis

Threapleton

Wang

et al. 2015

BMJ

163

123

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“…However, other studies reported that levofloxacin-containing regimens did not have superior eradication rates compared to other treatments. Metaanalyses and a recent study in 2014 have shown that the outcome of levofloxacin-based first-line therapy was similar to STT [115,116] with an overall crude eradication rate of 79.1% in the levofloxacin group compared to 81.4% in the STT group [116] . A recent RCT in Taiwan with over 153 patients determined there was an advantage to levofloxacin-amoxicillin/clavulanate-PPI therapy over STT, although there was a low eradication rate (ITT analysis: 78.1% vs 57.5%) [117] .…”

Section: Quinolones To Existing Treatmentmentioning

confidence: 99%

Antibiotic treatment forHelicobacter pylori: Is the end coming?

Kim

Choi

Chung

2015

WJGPT

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Infection with the Gram-negative pathogen Helicobacter pylori (H. pylori ) has been associated with gastroduodenal disease and the importance of H. pylori eradication is underscored by its designation as a group I carcinogen. The standard triple therapy consists of a proton pump inhibitor, amoxicillin and clarithromycin, although many other regimens are used, including quadruple, sequential and concomitant therapy regimens supplemented with metronidazole, clarithromycin and levofloxacin. Despite these efforts, current therapeutic regimens lack efficacy in eradication due to antibiotic resistance, drug compliance and antibiotic degradation by the acidic stomach environment. Core tip: This article reviews the recent literature describing antibiotic resistance and trends in Helicobacter pylori (H. pylori ) treatment. As there is no effective conventional therapy, new treatments are being developed and bismuth quadruple, sequential, concomitant therapies are recommended as a first-line regimen in regions with high levels of clarithromycin resistance. Quinolones have also been used for H. pylori treatment, although the cure rate has gradually reduced with this approach. New therapeutic directions include probiotic supplementation, tailored therapy, novel agents, and nanotechnology.

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Levofloxacin and proton pump inhibitor‐based triple therapy versus standard triple first‐line therapy for Helicobacter pylori eradication

Abstract: Levofloxacin-based therapy was as safe and effective as triple therapy for H. pylori infection and could be considered as an additional treatment option. However, more rigorous research is required to accurately assess the role of levofloxacin in eradicating H. pylori infection.

Cited by 18 publications

References 67 publications

Treatment of Helicobacter pylori Infection 2015

Treatment of Helicobacter pylori Infection 2015

Comparative effectiveness and tolerance of treatments forHelicobacter pylori: systematic review and network meta-analysis

Antibiotic treatment forHelicobacter pylori: Is the end coming?

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