Moxifloxacin‐Containing Triple Therapy as Second‐Line Treatment for <i>Helicobacter pylori</i> Infection: Effect of Treatment Duration and Antibiotic Resistance on the Eradication Rate

Aim: It is recommended that treatments that include clarithromycin should be avoided in eradication of Helicobacter pylori (HP) in cases where clarithromycin resistance is higher than 20%. We aimed to compare levofloxacin- and moxifloxacin-based triple therapies with standard treatment and with each other in eradication of helicobacter pylori as first-line therapy. Materials and Methods: Patients were randomized prospectively as three groups. There were 102 patients in the levofloxacin group, 101 patients in the moxifloxacin group, and 103 patients in the standard treatment group. The patients received levofloxacin 500 mg daily, amoxicillin 1 g b.i.d. and lansoprazole 30 mg b.i.d. for ten days (LAL) in the levofloxacin group; moxifloxacin 400 mg daily, amoxicillin 1 g b.i.d. and lansoprazole 30 mg b.i.d. (MAL) in the moxifloxacin group; and clarithromycin 500 mg b.i.d., amoxicillin 1 g b.i.d. and lansoprazole 30 mg b.i.d. (CAL) in the standard treatment group. At post-treatment week 6, HP was checked by using stool antigen test. Results: In the eradication of Helicobacter pylori, the success rate as determined by per protocol (PP) analysis was 92% in the LAL group, 91.8% in the MAL group, and 82.4% in the CAL group. A statistically significant difference was found in the LAL and MAL groups compared to the CAL group (p < 0.05). There was no difference between the LAL and MAL groups. Conclusions: It was determined that levofloxacin- and moxifloxacin-based triple therapies were more effective than the standard treatment in first-line setting in the eradication of Helicobacter pylori. In addition, no difference was found between levofloxacin- and moxifloxacin-based triple therapies. Currently observed high efficacy may be evaluated in treatment. Although quinolon resistance is not considered a major problem, it appears to be a factor that may reduce treatment success over a period of time.

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“…Similar rates are reported for moxifloxacin resistance [16,17,18,19,20]. Quinolon resistance increases with age and duration of use.…”

Section: Discussionsupporting

confidence: 65%

Comparison of Levofloxacin- and Moxifloxacin-Based Triple Therapies with Standard Treatment in Eradication of Helicobacter Pylori as First-Line Therapy

Rakici

Ayaz²,

Akdoğan³

et al. 2014

Digestion

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“…Initially, the combination of a PPI, amoxicillin, and moxifloxacin as the first-line regimen was associated with favourable results [23][24][25][26][27][28][29]. Later on, other authors studied this same regimen in patients with one previous eradication failure (standard triple therapy) and reported variable results [30][31][32][33][34], with eradication rates ranging from 67% to 76%. However, the sample size of these studies was low, all of them including less than 200 patients.…”

Section: Discussionmentioning

confidence: 99%

Two-week, high-dose proton pump inhibitor, moxifloxacin triple Helicobacter pylori therapy after failure of standard triple or non-bismuth quadruple treatments

Gisbert¹,

Romano²,

Molina–Infante³

et al. 2015

Digestive and Liver Disease

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“…Seventy-nine patients were resistant to conventional triple therapy, and they were given a 7-day course of 400 mg moxifloxacin once daily, 1000 mg amoxicillin twice, and 20 mg esomeprazole twice [16]. Sixty-one patients were responders (77.1 %) with improvement of their mean platelet count from (76.4 ± 17.4 × 10 3 /μL to 104.2 ± 15.2 × 10 3 /μl, p = 0.000).…”

Section: Prevalence Of Active Helicobacter Infection In the Study Patmentioning

confidence: 99%

Impact of Helicobacter pylori eradication on refractory thrombocytopenia in patients with chronic HCV awaiting antiviral therapy

Hanafy

Hawary

Hamed

et al. 2016

Eur J Clin Microbiol Infect Dis

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The possibility of delaying treatment of HCV due to severe thrombocytopenia is challenging. This study aimed to detect the prevalence of active helicobacter infection as a claimed cause of thrombocytopenia in a cohort of Egyptian patients with chronic active HCV awaiting combined anti-viral therapy. The study included 400 chronic HCV patients with thrombocytopenia. Laboratory investigations included liver function tests, real time quantitative PCR, reticulocytic count, ESR, ANA, bone marrow aspiration, measurement of anti-helicobacter antibodies, and helicobacter stool antigen. Positive cases for active H. pylori were given the standard triple therapy for 2 weeks. Helicobacter stool antigen was detected 4 weeks after termination of therapy and the change in platelet count was detected 1 month after eradication. A total of 248 out of 281 seropositive patients for H. pylori (88.3 %) showed positive stool antigen (p = 0.01). Eradication was achieved in 169 (68.1 %) patients with platelet mean count 114.9 ± 18.8 × 10(3)/μl with highly significant statistical difference from pretreatment value (49.7 ± 9.2 × 10(3)/μl, p = 0.000). Seventy-nine patients were resistant to conventional triple therapy and given a 7-day course of moxifloxacin-based therapy; 61 patients responded (77.1 %) with mean platelet improvement from 76.4 ± 17.4 × 10(3)/μl to 104.2 ± 15.2 × 10(3)/μl (p = 0.000). The non-responders showed no improvement in their platelet count (74.6 ± 20.5 vs. 73.6 ± 15.3 × 10(3)/ul, P = 0.5). Eradication of active H. pylori in HCV augments platelet count and enhances the early start of antiviral therapy.

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Moxifloxacin‐Containing Triple Therapy as Second‐Line Treatment for Helicobacter pylori Infection: Effect of Treatment Duration and Antibiotic Resistance on the Eradication Rate

Cited by 52 publications

References 40 publications

Comparison of Levofloxacin- and Moxifloxacin-Based Triple Therapies with Standard Treatment in Eradication of Helicobacter Pylori as First-Line Therapy

Comparison of Levofloxacin- and Moxifloxacin-Based Triple Therapies with Standard Treatment in Eradication of Helicobacter Pylori as First-Line Therapy

Two-week, high-dose proton pump inhibitor, moxifloxacin triple Helicobacter pylori therapy after failure of standard triple or non-bismuth quadruple treatments

Impact of Helicobacter pylori eradication on refractory thrombocytopenia in patients with chronic HCV awaiting antiviral therapy

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