Levofloxacin-Based First-Line Therapy versus Standard First-Line Therapy for Helicobacter pylori Eradication: Meta-Analysis of Randomized Controlled Trials

Peedikayil, Musthafa; Alsohaibani, Fahad; Alkhenizan, Abdullah

doi:10.1371/journal.pone.0085620

Cited by 30 publications

(25 citation statements)

References 39 publications

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“…Although not formally compared, the pooled eradication rate of levofl oxacin triple therapy was also higher than clarithromycin triple therapy for 10-14 days (81%, 95% CI, 78-84%). Tolerability of levofl oxacin triple therapy appears to be similar to clarithromycin triple therapy ( 103,138 ).…”

Section: Sequential Therapymentioning

confidence: 99%

ACG Clinical Guideline: Treatment of Helicobacter pylori Infection

Chey

Leontiadis

Howden

et al. 2017

American Journal of Gastroenterology

1,319

1,505

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Helicobacter pylori ( H. pylori ) infection is a common worldwide infection that is an important cause of peptic ulcer disease and gastric cancer. H. pylori may also have a role in uninvestigated and functional dyspepsia, ulcer risk in patients taking low-dose aspirin or starting therapy with a non-steroidal anti-infl ammatory medication, unexplained iron defi ciency anemia, and idiopathic thrombocytopenic purpura. While choosing a treatment regimen for H. pylori , patients should be asked about previous antibiotic exposure and this information should be incorporated into the decision-making process. For fi rst-line treatment, clarithromycin triple therapy should be confi ned to patients with no previous history of macrolide exposure who reside in areas where clarithromycin resistance amongst H. pylori isolates is known to be low. Most patients will be better served by fi rst-line treatment with bismuth quadruple therapy or concomitant therapy consisting of a PPI, clarithromycin, amoxicillin, and metronidazole. When fi rst-line therapy fails, a salvage regimen should avoid antibiotics that were previously used. If a patient received a fi rst-line treatment containing clarithromycin, bismuth quadruple therapy or levofl oxacin salvage regimens are the preferred treatment options. If a patient received fi rst-line bismuth quadruple therapy, clarithromycin or levofl oxacin-containing salvage regimens are the preferred treatment options. Details regarding the drugs, doses and durations of the recommended and suggested fi rst-line and salvage regimens can be found in the guideline. Asia and Central and South America ( 8,22 ). Th ere is, however, preliminary evidence that it may be falling in some previously high prevalence areas ( 22 ). People immigrating to North America from Asia and other parts of the world have a much higher prevalence of the infection than people born in North America ( 23 ). In one study, the seroprevalence among immigrants from East Asia was 70.1% ( 24 ). Hispanic immigrants to North America have higher rates of the infection than fi rst-or second-generation Hispanics who were born here ( 25 ). QUESTION 2: WHAT ARE THE INDICATIONS TO TEST FOR, AND TO TREAT, H. PYLORI INFECTION? RecommendationsSince all patients with a positive test of active infection with H. pylori should be off ered treatment, the critical issue is which patients should be tested for the infection (strong recommendation, quality of evidence: not applicable), All patients with active peptic ulcer disease (PUD), a past history of PUD (unless previous cure of H. pylori infection has been documented), low-grade gastric mucosa-associated lymphoid tissue (MALT) lymphoma, or a history of endoscopic resection of early gastric cancer (EGC) should be tested for H. pylori infection. Th ose who test positive should be off ered treatment for the infection (strong recommendation, quality of evidence: high for active or history of PUD, low for MALT lymphoma, low for history of endoscopic resection of EGC).In patients with uninvestigated d...

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Section: Sequential Therapymentioning

confidence: 99%

ACG Clinical Guideline: Treatment of Helicobacter pylori Infection

Chey

Leontiadis

Howden

et al. 2017

American Journal of Gastroenterology

1,319

1,505

View full text Add to dashboard Cite

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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: 89%

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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“…Recently, however, it has been known that quinolone, that inhibits deoxyribonucleic acid gyrase, is effective in the treatment of H. pylori infection [46][47][48]. Additionally, many studies support that quinolonebased sequential therapy is effective in an area with >15% prevalence of clarithromycin resistant H. pylori strains [49,50].…”

Section: Quinolone-based Sequential Therapymentioning

confidence: 99%

The first-line regimens of Helicobacter pylori eradication in Korea

Park

2017

Hanyang Med Rev

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This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.Approximately half of the world's population is infected by Helicobacter pylori, which causes various gastrointestinal diseases including gastritis, peptic ulcer, gastric mucosa-associated lymphoid tissue lymphoma, and gastric cancer. The conventional triple therapy, that consists of proton pump inhibitor (PPI), amoxicillin, and clarithromycin, is widely used in Korea because of high resistance rates of H. pylori against metronidazole. Recently, however, clarithromycin-resistance rates have also increased and the eradication rate of conventional triple therapy has been unacceptable. In order to increase the eradication rate of H. pylori, various regimens have been suggested. Understanding H. pylori eradication regimens will help select drugs in the management of H. pylori infection.

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Levofloxacin-Based First-Line Therapy versus Standard First-Line Therapy for Helicobacter pylori Eradication: Meta-Analysis of Randomized Controlled Trials

Cited by 30 publications

References 39 publications

ACG Clinical Guideline: Treatment of Helicobacter pylori Infection

ACG Clinical Guideline: Treatment of Helicobacter pylori Infection

Antibiotic treatment forHelicobacter pylori: Is the end coming?

The first-line regimens of Helicobacter pylori eradication in Korea

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