Abstract
H. pylori infection is the main cause of gastritis, gastroduodenal ulcer disease, and gastric cancer. Fluoroquinolones such as levofloxacin, or more recently moxifloxacin or sitafloxacin, are efficacious alternatives to standard antibiotics for H. pylori eradication. The aim of the present review is to summarize the role of quinolone-based eradication therapies, mainly focusing on the optimization strategies aimed to increase their efficacy. Several meta-analyses have shown that, after failure of a first-line eradication treatment, a levofloxacin-containing rescue regimen is at least equally effective, and better tolerated, than the generally recommended bismuth quadruple regimen. Compliance with the levofloxacin regimens is excellent, and the safety profile is favourable. Higher cure rates have been reported with longer treatments (>10–14 days), and 500 mg levofloxacin daily is the recommended dose. Adding bismuth to the standard triple regimen (PPI-amoxicillin-levofloxacin) has been associated with encouraging results. Unfortunately, resistance to quinolones is easily acquired and is increasing in most countries, being associated with a decrease in the eradication rate of H. pylori. In summary, a quinolone (mainly levofloxacin)-containing regimen is an encouraging second-line (or even third-line) strategy, and a safe and simple alternative to bismuth quadruple therapy in patients whose previous H. pylori eradication therapy has failed.
Highlights
Helicobacter pylori (H. pylori) is a worldwide infection that is the main cause of gastric cancer and gastroduodenal ulcer disease [1]
A rescue regimen including a quadruple combination of a pump inhibitor (PPI), bismuth, tetracycline, and metronidazole has been used as the optimal second-line approach after initial H. pylori eradication failure [4,5,6]
Several meta-analyses have evaluated the efficacy of quinolone-based H. pylori eradication regimens, their main characteristics and conclusions being summarized in Table 1 [18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34]
Summary
Helicobacter pylori (H. pylori) is a worldwide infection that is the main cause of gastric cancer and gastroduodenal ulcer disease [1]. A rescue regimen including a quadruple combination of a PPI, bismuth, tetracycline, and metronidazole has been used as the optimal second-line approach after initial H. pylori eradication failure [4,5,6]. This regimen fails to eradicate the infection in at least 20% of cases [7,8,9,10]. Recent findings indicate that some fluoroquinolones such as levofloxacin, or more recently moxifloxacin or sitafloxacin, seem to be efficacious alternatives to standard antibiotics, mainly as rescue regimens after initial H. pylori eradication failure. H. pylori infection, mainly focusing on the optimization strategies aimed to increase the efficacy of quinolone-based eradication therapies
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