Levofloxacin-based Triple Therapy Research Articles

Outcome of 14-Day Sequential and Levofloxacin-Based Triple Regimen as the First-Line Therapy in Patients with Helicobacter pylori Infection: A Prospective Comparative Study from Southern Central Nepal

Background Helicobacter pylori eradication rates of the commonly used regimens vary among countries and even among different regions of the same country. We aimed to compare the eradication rate and safety of sequential therapy with levofloxacin-based triple therapy. Methods A comparative single-center study was conducted between October 2022 and November 2023 after obtaining ethical approval. Patients in group A received 14 days of levofloxacin-based triple therapy and those in group B received 14 days of sequential therapy. The eradication of H. pylori was assessed 4 weeks after the completion of the assigned regimens. The data regarding adverse events were also recorded. Results Among 150 patients (group A: 70, group B: 80) with mean age of 41.7 ± 15.0 years, 67 (44.6%) were male. The eradication was achieved in 65 (92.9%) in group A and 63 (78.8%) in group B, respectively (p = 0.01). All the patients in group A and 76 (95%) patients in group B had good compliance with medication. Adverse events were noticed in 7 (10%) in group A compared to 31 (38.7%) in group B (p < 0.001). The most common adverse events in group A and group B were drug-related diarrhea (3 [4.3%] vs. 11 [13.7%]), gastrointestinal intolerance (2 [2.8%] vs. 6 [7.5%]), and bad/metallic taste (1 [1.4%] vs. 22 [27.5%]). No serious adverse events were noted in both groups. Conclusion Sequential therapy is significantly less effective and has more nonserious adverse events compared to levofloxacin-based triple therapy in eradication of H. pylori.

Second-line Therapy for Helicobacter Pylori Eradication: State of the Art.

Helicobacter pylori (H. pylori) is a Gram negative spiraliform bacterium that colonizes the human stomach. It is the most common cause of chronic gastritis, peptic ulcer, and gastric carcinoma. The eradication therapy is based on the combination of a proton pump inhibitor and several antibiotics such as amoxicillin, metronidazole, clarithromycin, levofloxacin or tetracycline. The most commonly used regimens for eradication in the first line are triple, sequential and concomitant therapy, despite the last European Guidelines suggesting a quadruple therapy already at the first attempt in areas with high resistance rates. However, the rise in antibiotic resistance is the main reason for a marked increase in first-line therapy failure. Clarithromycin resistancea, is especially acknowledged as the most important event resulting in failure. Up to 20% of patients are intended not to eradicate, therefore they will need a second line therapy. Currently, the most used rescue regimens are levofloxacin-based triple therapy and bismuth-containing quadruple therapy, despite guidelines suggesting to use a combination of antibiotics that have not been included in previous treatments. Nitazoxanide is a novel antibiotic with promising results. Additionally, an interesting field worth of investigation is the antibiotic susceptibility based approach, which could help choose antibiotics with confirmed effectiveness in vitro. Analysis of antibiotic resistance may be performed by both bacterial culture and molecular biology techniques, able to detect point mutations conferring resistance. This is a particularly interesting approach, since it may personalize the therapy, thus optimizing the regimen and maximizing the probability of success.

Comparative Effectiveness of Various Eradication Regimens for Helicobacter Pylori Infection in the Northeastern Region of Poland.

Purpose: Due to the lack of systematic data on antibiotic sensitivity, the treatment of the highly prevalent and pathogenic Helicobacter pylori (H. pylori) infection still poses a significant problem. Therefore, the aim of our study was to compare the efficacy of the three most commonly used anti-H. pylori therapies in northeastern Poland. Patients and Methods: This was a retrospective, single-center study performed on 289 outpatients with an H. pylori infection. Patients received one of the following three treatment regimens: (1) bismuth quadruple therapy (BQT) for 10 days, (2) metronidazole-based triple therapy (M-TT) for 10 or 14 days, and (3) levofloxacin-based triple therapy (L-TT) for 10 or 14 days. Results: BQT, M-TT, and L-TT accounted for 93.2% of prescribed anti-H. pylori therapies. The overall success rate for all treatment regimens was 84.1% (243/289). The effectiveness of first- and second-line therapy was similar and reached 83.8% and 86.2%, respectively. The efficacy of the individual treatment regimens was as follows: (1) BQT—89.4% (84/94), (2) M-TT—80.6% (112/139) and 78.8% (26/33) for 10 and 14 days, respectively, and (3) L-TT—84.6% (11/13) and 100% (10/10) for 10 and 14 days, respectively. The overall duration of treatment and type and dose of proton pump inhibitor (PPI) had no effect on the treatment efficacy. Conclusions: In the northeastern part of Poland, 10-day BQT and 10- or 14-day L-TT are effective treatment regimens for H. pylori eradication and have appear to be superior to M-TT. Practitioners in our clinic followed mostly local anti-H. pylori therapy guidelines.

Levofloxacin-based therapy as an efficient alternative for eradicating Helicobacter pylori infection in Iran: a systematic review and meta-analysis

Despite excessive resistance of Helicobacter pylori to clarithromycin among the Iranian population, clarithromycin-based therapy is still prescribed in Iran. Recent studies have shown high rates of H. pylori eradication in patients treated with levofloxacin. The main purpose of this study was to compare the effect of levofloxacin with clarithromycin on the eradication of H. pylori infection in the Iranian population. A comprehensive meta-analysis was done for relevant cohort studies and clinical trials to compare the therapeutic effects of levofloxacin and clarithromycin in the Iranian population. We pooled the data using odds ratio (OR) and corresponding 95% confidence interval (CI) to determine the clinical efficacy of levofloxacin versus clarithromycin to treat H. pylori infection. Heterogeneity and publication bias were also measured for the included studies. Thirteen studies were included in the quantitative synthesis. The eradication rate was significantly higher in patients receiving levofloxacin compared with clarithromycin (75.2% vs. 66.3%; OR=1.76, 95% CI 1.40-2.20). Additionally, in the subgroup analyses it was confirmed that the cure rate was relatively higher in levofloxacin-treated cases. However, there was significant heterogeneity and publication bias, thus the results should be interpreted with caution. We found that the success of levofloxacin treatment was significantly higher than clarithromycin. Therefore, it is suggested that clarithromycin-based triple therapy be replaced by levofloxacin-based triple therapy in countries with high resistance to clarithromycin such as Iran. Nevertheless, the findings of this study need to be approved with a larger investigation on the Iranian population.

Tailored Helicobacter pylori therapy is more effective than conventional therapy

Background and aims Tailored (culture and sensitivity) therapy has gained attention over recent years as an effective option for eradication of Helicobacter pylori infection. The authors aimed to assess the efficacy of antibiotics sensitivity-guided therapy versus clarithromycin or levofloxacin triple therapies as the first-line therapy for H. pylori. Patients and methods Dyspeptic patients who underwent esophagogastroduodenoscopy were prospectively enrolled. Patients with positive H. pylori results by the rapid urease test were randomized to receive either antibiotics sensitivity-guided therapy or empirical clarithromycin or levofloxacin-based triple therapy for 14 days. Antimicrobial sensitivity tests for seven antibiotics (clarithromycin, amoxicillin, metronidazole, levofloxacin, tetracycline, nitrofurantoin, and rifampicin) were performed using the disk-diffusion method. Group A received antibiotics sensitivity-guided therapies that included esomeprazole plus two antibiotics for which the isolates were sensitive and group B received conventional therapies that included esomeprazole, amoxicillin plus clarithromycin or levofloxacin for 2 weeks. Eradication of H. pylori was checked using stool antigen 4 weeks after therapy. Results A total of 25 patients completed the study in each group. Both studied groups were matched for baseline characteristics. The most commonly used regimen in the antimicrobial sensitivity-based therapy was clarithromycin-based triple therapy (46.5%), followed by levofloxacin-based triple therapy and levofloxacin and nitrofurantoin plus esomeprazole. The association analysis demonstrated that, in the intention-to-treat populations, the H. pylori eradication rate was significantly higher in the antibiotic sensitivity-guided therapy group [85.7% (24/28) vs. 53.3% (16/30) in the conventional therapy group (P=0.035). In the per-protocol populations, the eradication rate was 96% for the sensitivity-guided therapy group and 64% for the conventional therapy group (P=0.005). The rates of adverse events were similar in both sensitivity-guided and conventional therapies, with no significant differences (P=0.527). Conclusions Culture-based eradication therapy demonstrated superior eradication rates than empirical therapy as a first-line therapy for H. pylori in a region with high rates of antimicrobial resistance.

Helicobacter Pylori Eradication Therapy: Still a Challenge.

IntroductionHelicobacter pylori (H. pylori) infection is prevalent worldwide. H. pylori therapies' adverse effects can contribute to noncompliance among patients. This study aimed to assess the association between compliance to H. pylori eradication therapy and adverse effects using various drug regimens.MethodWe conducted an observational study from September 2017 to February 2020 in two tertiary care hospitals in patients with dyspeptic symptoms. H. Pylori detection was done by histopathological examination of gastric mucosa during upper gastrointestinal endoscopy or stool for H. pylori antigen. Patients with positive results were randomly assigned one of the nine different regimens consisting of a combination of proton pump inhibitors along with at least two antibiotics. The antibiotics used in different combinations were amoxicillin, clarithromycin, metronidazole, doxycycline, levofloxacin, and bismuth sulfate. The treatment groups received standard triple therapy with and without probiotics, sequential, concomitant, levofloxacin-based triple therapy, or sequential and bismuth-based quadruple treatments. All treatments were given for two weeks. At the end of the treatment period, patients were interviewed about completing treatment and any adverse effects they may have experienced during therapy. Data were analyzed using IBM Statistical Package for the Social Sciences (SPSS) Statistics for Windows, Version 22.0 (Armonk, NY: IBM Corp.).ResultsA total of 250 patients were included in the study (62% males, 38% females) with a mean age of 37 years ± 13 years (range 12-84 years). Most patients completed the treatment regimen (80.4%), and 19.6% did not complete treatment because of adverse effects (p<0.005). The levofloxacin-based, concomitant, and standard triple regimen with probiotic treatments had the highest tolerance (≥85%). Common adverse effects were abdominal and epigastric pain (11%), alteration of taste, and diarrhea (6.5%).ConclusionH. pylori eradication therapy is always a challenge. Patient compliance to the treatment can only be ensured by medicines with fewer adverse effects. In our study, levofloxacin-based triple, concomitant, and standard triple regimens with probiotics are maximally acceptable treatments.

RETRACTED: Intelligent hospital and clinical effect of omeprazole in the treatment of patients with gastric ulcer based on embedded system

Abstract The most common cause of peptic ulcer disease has been implanted medical Helicobacter pylori infection and used test for the detection and treatment strategies. Pylori, based on the larger of the age of more than 55 years, to reduce the risk of gastric cancer, non-alarm condition is young, is a good situation. Most of the other patients, should undergo endoscopy to rule out cancer of serious cause indigestion. Urea, and respiratory test and stool antigen test is used to identify the most accurate. Helicobacter pylori infection, and it can be used in order to confirm that it has cured. Serology is convenient, is an alternative less accurate, and cannot be used in order to confirm the healing. Treatment options, the standard triple therapy, sequential therapy, quadruple therapy, and levofloxacin-based triple therapy. Gastric parietal cell height and quality in patients than in months, biopsies from patients within a few months compared to an increase of drug omeprazole longer. Embedded sections and electron microscopy shows that the expansion of the protruding sparse cytoplasm secretion by parietal cells. Cell wall hypertrophy and hyperplasia of patients develop chronic omeprazole; can be confirmed in a routine examination of tissue sections. These morphological changes and increased duration of treatment.

Efficacy and safety of 7 days versus 10 days triple therapy based on levofloxacin-dexlansoprazole for eradication of Helicobacter pylori: A pilot randomized trial

BACKGROUND:Levofloxacin-based triple therapies are considered the standard regimen for eradication of Helicobacter pylori (H. pylori) due to decreased sensitivity to clarithromycin and the optimal duration of therapy is still controversial. Besides, there is no complete evidence about dexlansoprazole efficacy in the eradication of H. pylori.AIM:Our study aimed to determine the effectiveness of triple therapy based on levofloxacin-dexlansoprazole as a standard treatment for H. pylori infection and estimate the effect of H. pylori on lipid profile and hemoglobin (Hb).MATERIALS AND METHODS:A pilot prospective randomized trial of a triple therapy based on levofloxacin-dexlansoprazole for H. pylori eradication was conducted at Damanhour Medical National Institute, Egypt; 66 participants with H. pylori infection received levofloxacin (500 mg/day) plus amoxicillin (1 g/12 h) plus dexlansoprazole (60 mg/day). All medications administrated orally for either 7 days or 10 days. Four weeks after treatment, the eradication was assessed by the stool antigen test.RESULTS:The rate of eradication was 63.6% in levofloxacin, amoxicillin, and dexlansoprazole (LAD) 7-day group, and 90.9% in LAD 10-day group. In addition, laboratory test results showed a significant difference in Hb, low-density lipoprotein, high-density lipoprotein, triglyceride, and total cholesterol levels before and after treatment (P < 0.05).CONCLUSION:LAD 10 days is the least duration that provides maximum efficacy for H. pylori in Egyptian participants. In addition, successful treatment of H. pylori infection may reduce the risk of anemia and dyslipidemia. Furthermore, all members of the patient’s family should be screened for H. pylori to prevent recurrent infection.

Helicobacter pylori Treatment Strategies in Singapore.

The management of Helicobacter pylori infection in Singapore remains a clinical challenge. Similar to other regions, there has been an increase in antibiotic resistance rates through the years. Nonetheless, over the past two decades, clarithromycin-based triple therapy has continued to be used as the first line treatment option, with an eradication rate exceeding 90%, although the accepted treatment duration must now be lengthened from 1 to 2 weeks to maintain efficacy. Concomitant and sequential therapies did not demonstrate superiority over standard triple therapy. Current empiric second line treatment utilizes either bismuth-based quadruple therapy or levofloxacin-based triple therapy, but outcomes remain less than ideal. Identifying options to further improve treatment success rates is challenging. Strategies being considered include the use of potent acid suppressants, such as vonoprazan, and H. pylori culture and antibiotic susceptibility testing-guided therapy.

Bovine lactoferrin enhances the efficacy of levofloxacin-based triple therapy as first-line treatment of Helicobacter pylori infection: an in vitro and in vivo study.

ObjectivesTo evaluate the in vitro antimicrobial/antivirulence action of bovine lactoferrin and its ability to synergize with levofloxacin against resistant Helicobacter pylori strains and to analyse the effect of levofloxacin, amoxicillin and esomeprazole with and without bovine lactoferrin as the first-line treatment for H. pylori infection.MethodsThe bovine lactoferrin antimicrobial/antivirulence effect was analysed in vitro by MIC/MBC determination and twitching motility against six clinical H. pylori strains and a reference strain. The synergism was evaluated using the chequerboard assay. The prospective therapeutic trial was carried out on two separate patient groups, one treated with esomeprazole/amoxicillin/levofloxacin and the other with esomeprazole/amoxicillin/levofloxacin/bovine lactoferrin. Treatment outcome was determined with the [13C]urea breath test.Results In vitro, bovine lactoferrin inhibited the growth of 50% of strains at 10 mg/mL and expressed 50% bactericidal effect at 40 mg/mL. The combination of levofloxacin and bovine lactoferrin displayed a synergistic effect for all strains, with the best MIC reduction of 16- and 32-fold for levofloxacin and bovine lactoferrin, respectively. Bovine lactoferrin at one-fourth MIC reduced microbial motility significantly for all strains studied. In the in vivo study, 6 of 24 patients recruited had treatment failure recorded with esomeprazole/amoxicillin/levofloxacin (75% success, 95% CI 57.68%–92.32%), and in the group with esomeprazole/amoxicillin/levofloxacin/bovine lactoferrin, 2 out of 53 patients recruited had failure recorded (96.07% success, 95% CI 90.62%–101.38%).ConclusionsBovine lactoferrin can be considered a novel potentiator for restoring susceptibility in resistant H. pylori strains. Bovine lactoferrin added to a triple therapy in first-line treatment potentiates the therapeutic effect.

Диагностика Helicobacter pylori и выбор эрадикационной терапии: результаты анкетирования врачей в различных регионах Российской Федерации

Aim of investigation. To estimate doctors’ awareness on diagnostic methods and eradication treatment modes of Helicobacter pylori (H. pylori) infection in routine clinical practice. Material and methods. Overall 261 doctors of healthcare institutions in 15 cities of Russia (Orel, St. Petersburg, Veliky Novgorod, Smolensk, Krasnoyarsk, Ulyanovsk, Krasnodar, Arkhangelsk, Yaroslavl, Ufa, Bryansk, Kaliningrad, Nizhny Novgorod, Moscow and Tyumen) were surveyed in 2016-2017. Data acquisition provided voluntary anonymous application of questionnaire consisting of 12 questions that will allow estimating knowledge of indications to H. pylori testing, diagnostic methods for this infection and utilized antihelicobacter treatment modes. Results. Primary diagnostics of H. pylori infection is carried out at peptic ulcer and chronic gastritis by 85 and 84% of surveyed doctors, at GERD - by 59.4%, at NSAID -related gastropathy - by 32%, at MALT lymphoma by 32%, at stomach cancer - by 30.7% and at autoimmune thrombocytopenia - by 16.8% respectively. Primary diagnostics of infection is based mainly on invasive methods: histological method (41.8% of respondents) and rapid urease test (38%). Noninvasive diagnostic methods for H. pylori infection: 13C urea breath test, stool test for H. pylori antigens and serological method were applied by 29.5%; 32.2% and 34.4% of respondents respectively. Of 241 described antihelicobacter first-line treatment modes 49.8% of respondents checked completely adequate treatment in accordance to the Russian Gastroenterological Association (RGA) guidelines. Of specified modes mainly clarithromycinbased standard triple therapy, including combination to the bismuth agent was mentioned. H. pylori eradication efficacy control is carried out by adequate invasive tests, such as urea breath test and fecal antigen test being utilized by 17.4 and 16.2% of respondents respectively. The inadequate control using serological method and rapid urease test was recommended by 10.7 and 6.6% of surveyed doctors respectively. At the choice of second line antihelicobacter therapy mode components 34.8% of doctors complied to RGA guidelines. Quadrotherapy with bismuth agent was advocated by 28% of doctors, levofloxacin-based triple therapy by 6.8%. Conclusions. Overall, doctors from different regions of the Russian Federation are well aware of the primary diagnostic methods of H. pylori infection, indications for eradication therapy and first-line treatment mode. However, additional education is required to inform doctors on necessity for H. pylori eradication, efficacy control methods, mode of second line treatment and drug dosages.

Eradication of Helicobacter Pylori in Iran: A Review.

Helicobacter pylori (H. pylori) infection is one of the most common bacterial infections, affecting almost half of the world’s population. It is associated with peptic ulcer disease, gastric adenocarcinoma, and lymphoma. In Iran, the prevalence of H. pylori infection has been reported to be between 36% and 90% in different geographic regions. Several studies have assessed the efficacy of different therapeutic options for firstline and second-line H. pylori eradication in Iran; however, the results are conflicting. Therefore, we conducted a review to evaluate different studies in order to select the best options and to provide recommendations for H. pylori eradication in Iran. Accordingly, we searched through PubMed to obtain relevant randomized clinical trials published in English language up to June 2017. According to our study, among first-line eradication regimens, bismuth-based furazolidone- or clarithromycin-containing quadruple therapies, hybrid regimen, and concomitant therapy seem to be appropriate options. Also, 10- or 14-day clarithromycin-containing triple therapy can be used if local H. pylori resistance to clarithromycin is known to be less than 15%. For second-line H. pylori eradication, bismuth-based quadruple therapies and 14-day levofloxacin-based triple therapy can be used, provided that antibiotics other than those used in the first-line regimen are used. Third-line H. pylori eradication regimens have not been addressed in Iranian studies. However, most guidelines recommend treatment according to the results of culture and susceptibility testing. Although we limited our investigation to H. pylori eradication regimens in Iran, the results are transferrable to any region as long as the patterns of antibiotic resistance are the same.

Levofloxacin-based triple therapy versus bismuth-based quadruple therapy in the treatment of Helicobacter pylori as the rescue therapy: a meta analysis

Objective: To evaluate the efficacy of levofloxacin-based triple therapy and bismuth-based quadruple therapy in the treatment of Helicobacter pylori (Hp) infection as rescue regimens. Methods: Related randomized controlled trials assessing the efficacy and safety of levofloxacin-based triple therapy eradicating Hp as salvage treatment were retrieved from Pubmed, Cochrane Library, SPRINGER, VIP database, WanFang database and CKNI database. The literature quality was evaluated by the improved Jadad criterion. RevMan5.3 sofeware was applied to data analysis. The mergment model was chosen on the basis of the outcome of the heterogeneity tests and original data was pooled for meta-analysis. Publication bias assessed with funnel plots. Results: Ultimately seventeen literatures were included for meta-analysis, the analysis showed that the eradication rate of levofloxacin-based triple therapy was higher comparing to the bismuth-based quadruple therapy but the difference was not statistically significant(77.0% vs 68.7%, OR=1.52, 95%CI 0.96-2.42, P=0.34). In European countries, levofloxacin-based triple therapy was more effective than quadruple therapy(80.6% vs 68.5%, OR=2.18, 95%CI 1.25-3.81, P<0.05), while eradication rates of two groups in Asian countries were similar. The 7-day levofloxacin-based triple therapy and quadruple therapy showed comparable efficacy, whereas the 10-day levofloxacin-based triple therapy was significantly more effective than quadruple therapy(87.7% vs 61.3%, OR=4.92, 95% CI 3.09-7.82, P<0.05). The efficacy was not influenced by the dose of levofloxacin. The adverse effects were significantly lesser(19.1% vs 29.5%, OR=0.47, 95%CI 0.26-0.82, P<0.05), whereas the compliance rate was significantly higher in levofloxacin group (96.0% vs 89.9%, OR=2.27, 95%CI 1.33-3.87, P<0.05). Conclusions: Comparing with bismuth-based quadruple therapy, levofloxacin-based triple therapy has higher eradication rate, compliance rate and lesser side effects, so we recommend it as a second-line rescue therapy after front-line Hp eradication failure. The optimal second-line alternative scheme might differ among countries depending on quinolone resistance.

Peptik ülserli hastalarda ikinci basamak Helicobacter pylori eradikasyonunda bizmut bazlı 4’lü ve levofloksasin bazlı 3’lü tedavilerin karşılaştırılması: Tek merkezli pilot çalışma

Background and Aims: The aim of this prospective, randomized trial was to compare bismuth-based quadruple therapy with levofloxacin-based triple therapy for the second-line eradication of Helicobacter pylori in peptic ulcer disease. Materials and Methods: From March 2014 to August 2015, 18 Helicobacter pylori-positive patients with peptic ulcer disease were consecutively randomized into two groups after 14 days of clarithromycin-based classic triple eradication. Group 1 (n=10) was given bismuth-based quadruple therapy and group 2 (n=8) was given levofloxacin-based triple therapy. In both groups, lansoprazole (1x1) was completed in 12 weeks. After a 15-day washout period, a urea breath test and Helicobacter pylori stool antigen test were performed to monitor eradication. Results: Sixty percent of the patients in group 1 were female, mean age was 45.7±8.8 (range: 36- 66) years, and in group 2, the mean age was 45.1±7.9 years (range: 29-54). The urea breath test and Helicobacter pylori stool antigen test were negative in 9 patients in group 1 (eradication rate: 90%) and 3 patients in group 2 (eradication rate: 38%). There was a significant difference in the eradication rate between the two groups in favor of bismuth-based quadruple therapy (p < 0.005). Conclusion: We conclude that bismuth-based quadruple therapy is superior to levofloxacin-based triple therapy for the second-line eradication of Helicobacter pylori in peptic ulcer disease. Although the number of patients was low in our study, this result might have been due to levofloxacin resistance. We propose that regional differences may have a role in second- line therapy, and more comprehensive studies including more patients are needed to address this issue.

Efficacy of 1st-line bismuth-containing quadruple therapies with levofloxacin or clarithromycin for the eradication of Helicobacter pylori infection

Background:The aim of the present open-label, randomized control trial was to determine the clinical efficacy and safety of two 1-week bismuth-containing quadruple regimens and 1 levofloxacin-based triple regimen for the eradication of Helicobacter pylori infection in treatment-naive patients. The influence of susceptibility and host CYP2C19 polymorphisms on the efficacy was also evaluated.Methods:Eligible patients were randomly to receive esomeprazole and colloidal bismuth pectin along with clarithromycin and amoxicillin (EBCA), esomeprazole and colloidal bismuth pectin along with levofloxacin and amoxicillin (EBLA), or esomeprazole along levofloxacin and amoxicillin (ELA) for 1 week. The primary outcome was the eradication rate in the intention-to-treat (ITT) and per-protocol (PP) analyses.Results:Overall, 270 patients were randomized. The eradication rates in the above 3 groups were 80.25%, 89.66%, and 81.93% in PP analysis and 72.22%, 86.66%, and 75.56% in ITT analysis, respectively. The eradication rate of EBLA was significantly higher than that of EBCA (P = 0.016) in ITT analysis. No significant differences were found among these groups in terms of adverse effects and compliance. The efficacy was significantly affected by levofloxacin resistance for EBLA (P = 0.01) and ELA (P = 0.04), but not by polymorphisms of CYP2C19 gene for any of the 3 groups.Conclusion:All 1-week bismuth-containing quadruple therapies and levofloxacin-based triple therapy can obtain an acceptable eradication rate, and levofloxacin-based quadruple regimen exhibits the highest eradication rate. The antibiotic resistant rate of levofloxacin was associated with the eradication rate.

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

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.

English

English

Different bismuth-based therapies for eradicating Helicobacter pylori: Randomized clinical trial of efficacy and safety

Bismuth salts are used for treating dyspepsia, and they exert antibacterial effects on Helicobacter pylori. This study aimed to compare the efficacy and safety of three bismuth-containing combination regimens for H. pylori eradication in a Turkish population. In this single-center study, 149 patients, who were diagnosed with H. pylori infection with urea breath test and histopathological examination, were randomized to receive the following therapies for 14 days: (1) bismuth-containing clarithromycin-based triple therapy (CBS-LAC), (2) bismuth-containing levofloxacin-based triple therapy (CBS-LAL), and (3) bismuth-containing quadruple therapy (BCQT). Eradication rates were evaluated six weeks after the treatment by performing intention to treat (ITT) and per protocol (PP) analyses. In addition, data on side effect profiles and patient compliance were collected. PP and ITT analyses showed that eradication rates were 86% and 81.1%, respectively, with BCQT; 68.3% and 66.7%, respectively, with CBS-LAL therapy; and 65.3% and 59.3%, respectively, with CBS-LAC therapy. Eradication rates obtained using PP and ITT analyses were statistically significant for all the regimens. Addition of bismuth to standard triple and levofloxacin-based regimen did not show an acceptable increase in eradication rates. Therefore, BCQT may be preferred for the first-line treatment of H. pylori infection.

Antimicrobial resistance of Helicobacter pylori strains to five antibiotics, including levofloxacin, in Northwestern Turkey.

Antibiotic resistance is the main factor that affects the efficacy of current therapeutic regimens against Helicobacter pylori. This study aimed to determine the rates of resistance to efficacy clarithromycin, amoxicillin, tetracycline, levofloxacin and metronidazole among H. pylori strains isolated from Turkish patients with dyspepsia. H. pylori was cultured from corpus and antrum biopsies that were collected from patients with dyspeptic symptoms, and the antimicrobial susceptibility of H. pylori was determined using the E-test (clarithromycin, amoxicillin, tetracycline, metronidazole and levofloxacin) according to the EUCAST breakpoints. Point mutations in the 23S rRNA gene of clarithromycin-resistant strains were investigated using real-time PCR. A total of 98 H. pylori strains were isolated, all of which were susceptible to amoxicillin and tetracycline. Of these strains, 36.7% (36/98) were resistant to clarithromycin, 35.5% (34/98) were resistant to metronidazole, and 29.5% (29/98) were resistant to levofloxacin. Multiple resistance was detected in 19.3% of the isolates. The A2143G and A2144G point mutations in the 23S rRNA-encoding gene were found in all 36 (100%) of the clarithromycin-resistant strains. Additionally, the levofloxacin MIC values increased to 32 mg/L in our H. pylori strains. Finally, among the clarithromycin-resistant strains, 27.2% were resistant to levofloxacin, and 45.4% were resistant to metronidazole. We conclude that treatment failure after clarithromycin- or levofloxacin-based triple therapy is not surprising and that metronidazole is not a reliable agent for the eradication of H. pylori infection in Turkey.

Molecular Detection of Helicobacter pylori and its Antimicrobial Resistance in Brazzaville, Congo.

Helicobacter pylori infection is involved in several gastroduodenal diseases which can be cured by antimicrobial treatment. The aim of this study was to determine the prevalence of H. pylori infection and its bacterial resistance to clarithromycin, fluoroquinolones, and tetracycline in Brazzaville, Congo, by using molecular methods. A cross- sectional study was carried out between September 2013 and April 2014. Biopsy specimens were obtained from patients scheduled for an upper gastrointestinal endoscopy and were sent to the French National Reference Center for Campylobacters and Helicobacters where they were tested by molecular methods for detection of H. pylori and clarithromycin resistance by real-time PCR using a fluorescence resonance energy transfer-melting curve analysis (FRET-MCA) protocol, for detection of tetracycline resistance by real-time PCR on 16S rRNA genes (rrnA and rrnB), for detection of point mutations in the quinolone resistance-determining regions (QRDR) of H. pylori gyrA gene, associated with resistance to quinolones, by PCR and sequencing. This study showed a high H. pylori prevalence (89%), low rates of clarithromycin and tetracycline resistance (1.7% and 2.5%, respectively), and a high rate of quinolone resistance (50%). Therefore, the use of standard clarithromycin-based triple therapy is still possible as an empiric first-line treatment as well as prescription of bismuth-based quadruple therapy, which includes tetracycline, but not a levofloxacin-based triple therapy because of the high rate of resistance to fluoroquinolones.