Moxifloxacin-based Triple Therapy Research Articles

Predictors of Successful First-Line Helicobacter pylori Eradication with Fluoroquinolones in Pakistan: A Prospective Exploration of Demographic and Clinical Factors.

Growing antibiotic resistance complicates H. pylori eradication, posing a public health challenge. Inconclusive research on sociodemographic and clinical factors emphasizes the necessity for further investigations. Hence, this study aims to evaluate the correlation between demographic and clinical factors and the success rates of H. pylori eradication. A group of 162 H. pylori-positive patients were allocated randomly to receive either a ten-day moxifloxacin-based triple therapy or a levofloxacin-based sequential therapy. Eradication success was determined through the stool antigen test. Logistic regression analysis was utilized to figure out potential factors that contribute to H. pylori eradication success. Significantly higher H. pylori eradication rates were observed in the middle age group (COR: 3.671, p = 0.007), among females (p = 0.035), those with BMI ≥ 25 (COR: 2.011, p = 0.045), and non-smokers (COR: 2.718, p = 0.018). In multivariate analysis, age and smoking emerged as significant predictors (p < 0.05). Patients with comorbidities, excluding diabetes and hypertension (COR: 4.432, p = 0.019), dyspepsia (COR: 0.178, p < 0.001), and moxifloxacin triple therapy (COR: 0.194, p = 0.000), exhibited higher chances of eradication (p < 0.05). Further research is vital for tailored approaches to enhance eradication success.

Treatment of Helicobacter Pylori Infections Using Moxifloxacin-Triple Therapy Compared to Standard Triple and Quadruple Therapies

Helicobacter pylori (H. Pylori) is one of the most common infectious human pathogens. H. pylori could induce inflammation, that causes illnesses and disorders of upper gastrointestinal which including peptic ulcer diseases, dyspepsia, gastroesophageal reflux disease and gastric mucosa-associated lymphoid tissue (MALT) lymphoma. It is important to use a better tolerated and greatly effective eradication regimen. In this study, 75 newly diagnosed adult patients with H. pylori infection were included and completed the study, they were allocated into three groups with three different treatment regimens for H. pylori eradications; Group A (25 patients) received oral standard clarithromycin-based triple therapy for 14 days. Group B (25 patients) received oral bismuth based-quadruple therapy for 10 days. Group C (25 patients) received oral moxifloxacin-based triple therapy for 14 days. The results reported in this study indicated a significant higher eradication rate of Group B and Group C (84% and 80%, respectively) of patients with H. pylori infections compared to that of Group A (52%). The incidence of adverse effects were appeared as 72%, 64% and 24% of patients in group A, B and C respectively. The use of moxifloxacin triple regimen for H. pylori eradication, present with eradication efficacy parallel to that of quadruple regimen which were significantly higher compared to that of clarithromycin triple regimen. Also moxifloxacin triple therapy is more tolerable and does not increase the incidence of overall adverse effects compared to other regimens used in this study.

A Novel Three Drug Rigemen (Moxifloxacin –Omeprazole - Nitazoxanide) in Comparison to Traditional Triple Therapy for Treatment and Eradication of Naïve and Resistant H. Pylori Infection in Dyspeptic Patients

Background: Helicobacter pylori is one of the most common, medically prominent infection worldwide and one of the major causative factor of peptic ulcer disease. So, eradication of H. pylori is effective in healing ulcers, reducing the ulcer recurrence and eliminating the need for maintenance therapy. Objective: The aim of the work was to compare between the efficacy of traditional triple therapy and Moxifloxacin-based triple therapy in treatment of H. pylori infection and to evaluate the efficacy of moxifloxacin-based regimens as a rescue regimen for H. pylori eradication in resistant patients. Patients and methods: This study was carried out on 100 Helicobacter pylori (H. pylori)-infected patients (within the period between septemper, 2018 to May, 2019) who were enrolled from Hepatology, Gastroenterology & Tropical Medicine Department, Al Azhar University Hospitals (El-Hussein and BAB El-Shaarea). Results: Helicobacter pylori eradication results in group III as evaluated by monoclonal H. Pylori stool Ag, 6 weeks post therapeutic regimens reported that eradication rate was 76.9% (20 patients). Regarding post treatment clinical data in group III, 42.3% of patients remained having symptoms and 57.7% had acheived symptomatic improvement. Also, the best results were recorded for H.pylori eradication (90%) in group II who received moxifloxacin based triple therapy compared to group I (with eradication rate 62.9%) who received traditional triple therapy regimen. Thus the better results (76.9%) were achieved in group III (resistant patients from group I). Conclusion: The present results could state that moxifloxacin can overcome traditional triple therapy resistance.

A Novel Three Drug Rigemen (Moxifloxacin –Omeprazole - Nitazoxanide) in Comparison to Traditional Triple Therapy for Treatment and Eradication of Naïve and Resistant H. Pylori Infection in Dyspeptic Patients

Background: Helicobacter pylori is one of the most common, medically prominent infection worldwide and one of the major causative factor of peptic ulcer disease. So, eradication of H. pylori is effective in healing ulcers, reducing the ulcer recurrence and eliminating the need for maintenance therapy. Objective: The aim of the work was to compare between the efficacy of traditional triple therapy and Moxifloxacin-based triple therapy in treatment of H. pylori infection and to evaluate the efficacy of moxifloxacin-based regimens as a rescue regimen for H. pylori eradication in resistant patients. Patients and methods: This study was carried out on 100 Helicobacter pylori (H. pylori)-infected patients (within the period between septemper, 2018 to May, 2019) who were enrolled from Hepatology, Gastroenterology & Tropical Medicine Department, Al Azhar University Hospitals (El-Hussein and BAB El-Shaarea). Results: Helicobacter pylori eradication results in group III as evaluated by monoclonal H. Pylori stool Ag, 6 weeks post therapeutic regimens reported that eradication rate was 76.9% (20 patients). Regarding post treatment clinical data in group III, 42.3% of patients remained having symptoms and 57.7% had acheived symptomatic improvement. Also, the best results were recorded for H.pylori eradication (90%) in group II who received moxifloxacin based triple therapy compared to group I (with eradication rate 62.9%) who received traditional triple therapy regimen. Thus the better results (76.9%) were achieved in group III (resistant patients from group I). Conclusion: The present results could state that moxifloxacin can overcome traditional triple therapy resistance.

Sa1192 - Efficacy of 7-Day Bismuth-Based Quadruple Therapy Versus 14-Day Moxifloxacin-Based Triple Therapy for Second-Line Treatment of Helicobacter Pylori Infection

Sa1192 - Efficacy of 7-Day Bismuth-Based Quadruple Therapy Versus 14-Day Moxifloxacin-Based Triple Therapy for Second-Line Treatment of Helicobacter Pylori Infection

Ultimate eradication rate of Helicobacter pylori after first, second, or third-line therapy in Korea.

Resistance rates of Helicobacter pylori to clarithromycin, metronidazole, and quinolone are over 30% in South Korea. The aim of this prospective study was to evaluate the ultimate eradication rate of H. pylori after first, second, or third-line therapy in Korea. A cohort of 2202 patients with H. pylori was treated with proton pump inhibitor (PPI)-based triple therapy for seven days. In case of treatment failure or recurrence, moxifloxacin-based triple therapy (MA) or bismuth-based quadruple therapy (QUAD) was randomly given. When the second-line treatment failed or H. pylori recurred, the unused MA or QUAD was used as a third-line treatment. Eighty-six patients had recurrence at least once during consecutive lines of treatments. Among 2116 patients (intention-to-treat [ITT]) without recurrence, 1644 (77.7%, per-protocol [PP]) completely followed our treatment flow. The ITT and PP rates of first-line treatment were 69.8% and 89.3%. After second line, they reached 78.4% (ITT) and 98.4% (PP). The "final" eradication rate up to third line treatment were 80.0% (1692/2116) and 99.8% (1641/1644), respectively. Resistance to clarithromycin showed significantly lower eradication rate (OR 0.358, P < 0.001) than those with susceptible strains in multivariate analysis. However in PP analysis, there was no significant difference in ultimate success rate regarding resistance pattern. Final success rate of PP was high, 99.8% in Korea in spite of high antibiotic resistance rates. However, high rate of refusal of further treatment and follow-up loss made ITT eradication rate low. Proper strategy to improve the treatment adherence is needed.

The efficacy of moxifloxacin-based triple therapy in treatment of Helicobacter pylori infection: a systematic review and meta-analysis of randomized clinical trials

Recent evidence shows that moxifloxacin could exert an antimicrobial effect against Helicobacter pylori in both in vitro and in vivo models. To systematically evaluate whether moxifloxacin-containing triple therapy could improve eradication rates and reduce side effects in first-line or second-line anti-H. pylori treatment, eligible articles were identified by searches of electronic databases. We included all randomized trials comparing moxifloxacin-based triple therapy with standard triple or quadruple therapy during H. pylori eradication treatment. Statistical analysis was performed with Review Manager 5.0.10. Subanalysis/sensitivity analysis was also performed. We identified seven randomized trials (n=1263). Pooled H. pylori eradication rates were 79.03% (95%CI: 75.73-82.07) and 68.33% (95%CI: 64.44-72.04) for patients with moxifloxacin-based triple therapy or with standard triple or quadruple therapy, respectively (intention-to-treat analysis). The odds ratio (OR) was 1.82 (95%CI: 1.17-2.81), the occurrence of total side effects was 15.23% (95%CI: 12.58-18.20) and 27.17% (95%CI: 23.64-30.92) for groups with or without moxifloxacin, and the summary OR was 0.45 (95%CI: 0.26-0.77). In subgroup analyses, we noted that the second-line eradication rate in the moxifloxacin group was significantly higher than that in the quadruple therapy group (73.33 vs 60.17%, OR: 1.78, 95%CI: 1.16-2.73, P<0.001). However, there was no difference in first-line eradication treatment. Findings from this meta-analysis suggest that moxifloxacin-based triple therapy is more effective and better tolerated than standard triple or quadruple therapy. Therefore, a moxifloxacin-based triple regimen should be used in the second-line treatment of H. pylori infection.

Sa1922 Superiority of Acid Suppression for Esomeprazole-Based Helicobacter pylori Eradication Therapy in Japanese CYP2C19 Rapid Metabolizers

Background/Aims: The increasing trend of antibiotic resistance requires effective secondline Helicobacter pylori (H. pylori) treatment in high prevalence area of H. pylori. The aim of our study was to evaluate the reinfection rate of H. pylori that would determine the effect of the eradication therapy in long-term follow up period after second-line treatment. Methods: During 2003-2011, 898 patients who had failed previous H. pylori eradication on standard triple therapy were treated with either of two regimens: 1, esomeprazole (20 mg b.i.d), tripotassum dicitrate bismuthate (300 mg q.i.d), metronidazole (500 mg t.i.d), and tetracycline (500 mg q.i.d) (EBMT) or 2, moxifloxacin (400 mg q.d.), esomeprazole (40 mg b.i.d), and amoxicillin (1000 mg b.i.d.) (MEA). At four weeks after completion of eradication therapy, follow-up H. pylori tests were performed with 13C urea breath test or invasive tests (Giemsa histology, CLO test, and culture). In patients who were maintained continuous H. pylori negativity for the first year after eradication therapy, H. pylori status was assessed every year. Results: Mean follow-up periods were 34.1 months and 35.6 months in the quadruple therapy group (n = 65) and moxifloxacin group (n = 177), respectively. H. pylori reappeared in 9 (13.8%) of EBMT and in 31 (17.5%) of MEA, resulting in the annual reinfection rate of 4.88% and 3.13% per year, respectively (P = 0.496). In addition, recrudescence rate of EBMT and MEA group was found to be 1.52% and 3.28% (MEA), respectively (P = 0.679). Multivariate analysis showed that there was no association with any clinical risk factor for H. pylori reinfection. Conclusion: This long-term reinfection rate of H. pylori stayed rather low in both of bismuth-containing quadruple therapy and moxifloxacin-based triple therapy, thus reinfection cannot affect the choice of second-line treatment.

Sa1904 Efficacy of 7-Day and 14-Day Moxifloxacin-Based Triple Therapy Versus 7-Day and 14-Day Bismuth-Containing Quadruple Therapy As Second-Line Treatment for Helicobacter pylori Infection

Sa1904 Efficacy of 7-Day and 14-Day Moxifloxacin-Based Triple Therapy Versus 7-Day and 14-Day Bismuth-Containing Quadruple Therapy As Second-Line Treatment for Helicobacter pylori Infection

Sa1921 Long-Term Follow up Helicobacter pylori Reinfection Rate After Second-Line Treatment: Bismuth-Containing Quadruple Therapy Versus Moxifloxacin-Based Triple Therapy

Sa1921 Long-Term Follow up Helicobacter pylori Reinfection Rate After Second-Line Treatment: Bismuth-Containing Quadruple Therapy Versus Moxifloxacin-Based Triple Therapy

Moxifloxacin-based triple therapy combined with rebamipide for Helicobacter pylori eradication in type 2 diabetic patients

Objective To evaluate the efficacy of moxifloxacin-based triple therapy combined with rebamipide for Helicobacter pylori (Hp) eradication in type 2 diabetic patients.Methods Two-hundred age and sex matched type 2 diabetic patients with Hp infection and accompanied by gastrointestinal symptoms were assigned into rebamipide group (n =100) and placebo group (n =100).Both groups received moxifloxacin-based triple therapy for 10 d to eradicate Hp.Rebamipide was administrated in rebamipide group and placebo was administrated in placebo group for 30 d.All patients proceeded 14C-urea breath test (14C-UBT) hefore and 7-8 weeks after eradication therapy.The blood sugar indices,gastrointestinal symptom scores and Hp eradication rates were measured and compared.Those who had gained successful Hp eradication in both groups proceeded 14 C-UBT again 12 months after eradication therapy,and the re-infection rates of both groups were compared.Results There were no significant differences in the average fasting glucose,postprandial glucose and HbAlc levels between the rebamipide group and the placebo group before and after therapy (P ＞ 0.05),the gastrointestinal symptoms of the rebamipide group were improved more markedly than those of the placebo group after therapy (Rome Ⅲ Criteria,2.1 ± 0.9 vs.4.4 ± 0.7,P ＜ 0.01).The Hp eradication rate with both intention-to-treat (ITT) and per protocol (PP) analysis of the rebamipide group were higher than that of the placebo group [86.0％ (86/100) vs.73.0％ (73/100),P ＜ 0.05 and 92.5％ (86/93) vs.76.8％ (73/95),P ＜ 0.01].The re-infection rates with both ITT and PP analysis of those who had successful eradication in rebamipide group were lower than that in placebo group [19.8％ (17/86) vs.35.6％ (26/73),P＜0.05and20.5％ (17/83) vs.36.6％ (26/71),P＜0.05].Conclusions Moxifloxacin-based triple therapy combined with rebamipide has a more beneficial effect on Hp related symptoms,a higher Hp eradication rate and a lower Hp re-infection rate for type 2 diabetic patients. Key words: Diabetes mellitus, type 2; Helicobacter pylori; Therapy

Advantages of Moxifloxacin and Levofloxacin-based triple therapy for second-line treatments of persistent Helicobacter pylori infection: a meta analysis

The main aim of this meta-analysis was to compare the efficacy and safety of clarithromycin and second-generation fluoroquinolone-based triple therapy vs. bismuth-based quadruple therapy for the treatment of persistent Helicobacter pylori infection. A systematic literature search was conducted for articles and abstracts from 1981 to March 2009 using Medline, PubMed, EMBase, Google Scholar and CNKI (Chinese), Wanfang (Chinese) digital database and recent Digestive Disease Week, United European Gastroenterology Week, and European Helicobacter Study Group conferences were also performed. Boolean operators (NOT, AND, OR) were used in succession to narrow and widen the search. Sixteen articles and four abstracts met the inclusion criteria, and were included in the meta-analysis by using Review Manager 4.2.8. The eradication rates demonstrated that clarithromycin-based triple therapy is inferior to bismuth-based quadruple therapy (OR = 0.53, 95% CI: 0.35-0.80, P = 0.002). Thirteen RCTs compared levofloxacin-based triple therapy vs. bismuth-based quadruple therapy, the eradication rates of the two regimens were shown to have no significant difference (OR = 1.43, 95% CI: 0.82-2.51, P = 0.21). But the eradication rates demonstrated superiority of the 10-day levofloxacin-based triple therapy over 7-day bismuth-based quadruple therapy (OR = 4.79, 95% CI: 2.95-7.79, P < 0.00001). Levofloxacin-based triple therapy was better tolerated than bismuth-based quadruple therapy with lower rates of side effects (OR = 0.41, 95% CI: 0.27-0.61, P < 0.0001), and lower rates of discontinuation of therapy due to adverse events (OR = 0.13, 95% CI: 0.06-0.33, P < 0.0001). Furthermore, our meta-analysis suggested that the eradication rates of the moxifloxacin-based triple therapy has a slight superiority to bismuth-based quadruple therapy, but there was no significant difference between them. Second-generation fluoroquinolone-based triple therapy can be suggested as the regimen of choice for rescue therapy in the eradication of persistent H. pylori infection especially 10-day levofloxacin-based triple therapy.

Moxifloxacin-Based Triple Therapy Versus Clarithromycin-Based Triple Therapy for First-Line Treatment of Helicobacter pylori Infection: A Meta-Analysis of Randomized Controlled Trials

Moxifloxacin-based triple therapy has been suggested as an alternative first line therapy to clarithromycin-based triple therapy for Helicobacter pylori infection. To systematically review the efficacy and tolerance of moxifloxacin-based triple therapy, and to conduct a meta-analysis of studies comparing this regimen with clarithromycin-based triple therapy. A search of The Cochrane Library, PUBMED, EMBASE, EBM Review databases, Science Citation Index Expanded, and CMB (Chinese Biomedical Literature Database) was performed. Randomized controlled trials comparing moxifloxacin-based triple therapy to gold standard triple therapy in the first-line treatment of Helicobacter pylori infection were selected for meta-analysis. Relative risk was used as a measure of the effect of the two above-mentioned regimens with a fixed-effects model using the methods of DerSimonian and Laird. Four randomized controlled trials totaling 772 patients were included. The meta-analysis showed that the mean eradication rate was 84.1 (318/378) in the moxifloxacin-based triple therapy group and 73.6 (290/394) in the clarithromycin-based triple therapy group; there was statistical significance between the two groups (RR, 1.13; 95% CI, 1.01, 1.27; P=0.04). There were no statistically significant difference in the overall side effects (RR, 0.61; 95% CI, 0.25, 1.48; P<0.28). Moxifloxacin-based triple therapy is more effective and does not increase the incidence of overall side effects compared to clarithromycin-based triple therapy in the treatment of H. pylori infection.

Second-line treatment for Helicobacter pylori infection based on moxifloxacin triple therapy: a randomized controlled trial

In eradication of Helicobacter pylori infection, standard quadruple second-line therapy consisting of proton pump inhibitor (PPI), bismuth, metronidazole and tetracycline often fails and shows poor patient compliance. The aim of our study was to evaluate the efficacy and tolerability of moxifloxacin-based triple therapy as an alternative second-line protocol. A total of 160 patients, in whom the initial standard PPI triple therapy had failed to eradicate H. pylori infection, were included in the study. The initial H. pylori status was assessed using the (13)C-urea breath test. Patients were randomized to one of the following 7-day treatment regimens: (1) OMM: omeprazole 20 mg twice a day, moxifloxacin 400 mg/day, metronidazole 500 mg three times a day; and (2) OBMT: omeprazole 20 mg twice a day, colloidal bismuth subcitrate 120 mg four times a day, metronidazole 500 mg three times a day, tetracycline 500 mg four times a day. Patient compliance and adverse events were evaluated one week after completion of therapy. H. pylori status was re-assessed with the (13)C-urea breath test six weeks after the end of therapy. The eradication rates were 73.2% (60/82) and 78.9% (60/76) with moxifloxacin-based triple therapy, and 53.8% (42/78) and 64.6% (42/65) with bismuth-based quadruple therapy, by intention-to-treat (p = 0.018) and per-protocol (p = 0.088) analyses, respectively. Adverse events/intolerability were described in 12/82 patients in the OMM group and 18/78 patients in the OBMT group. Compliance with treatment was 92.7% in the OMM group and 83.3% in the OBMT group. Moxifloxacin-based triple therapy is a highly effective second-line eradication treatment in H. pylori infection. Because of its high levels of safety and tolerability, this protocol represents an adequate alternative to the standard bismuth-based quadruple therapy.

M1066 Second-Line Treatment for Helicobacter pylori Infection: 10-Day Moxifloxacin-Based Triple Therapy vs. 2-Week Quadruple Therapy

M1066 Second-Line Treatment for Helicobacter pylori Infection: 10-Day Moxifloxacin-Based Triple Therapy vs. 2-Week Quadruple Therapy

Second‐Line Treatment for Helicobacter pylori Infection: 10‐day Moxifloxacin‐Based Triple Therapy versus 2‐week Quadruple Therapy

The aim of this study was to test the efficacy of 10-day moxifloxacin-based triple therapy versus 2-week quadruple therapy for the second-line treatment of Helicobacter pylori infection. One hundred and ninety-two patients who had failed previous H. pylori eradication on standard triple therapy were randomized to one of two regimens: 1, moxifloxacin (400 mg q.d.), amoxicillin (1000 mg b.i.d.), and esomeprazole (20 mg b.i.d.) for 10 days (the 10MEA group), or 2, esomeprazole (20 mg b.i.d.), tripotassium dicitrate bismuthate (300 mg q.i.d.), metronidazole (500 mg t.i.d.), and tetracycline 500 mg (q.i.d.) for 14 days (the 14EBMT group). The eradication rates, drug compliances, and side-effect rates of these two regimens were compared. Eradication rates by intention-to-treat and per-protocol analyses in the 10MEA and 14EMBT groups were 71.9% and 82.6%, and 71.7% and 90.5% (p = .973 and .321), respectively. The 10MEA group was significantly superior to the 14EMBT group in terms of side-effect rates (12.2% vs. 39.6%, p = .001), and discontinuation rates due to side-effects were lower in the 10MEA group than in the 14EMBT group (0.7% vs. 13.2%, p < .001). Moreover, compliance was higher in the 10MEA group (94.2% (131/139)) than in the 14EBMT group (83.0% (44/53)) (p = .014). The 10-day moxifloxacin-based triple therapy was found to have a high eradication rate with few side-effects and good drug compliance. These findings suggest that this regimen is a safe and effective second-line treatment option for H. pylori infection in Korea.

Efficacy of Moxifloxacin‐Based Triple Therapy as Second‐Line Treatment for Helicobacter pylori Infection

Metronidazole and tetracycline-based second-line quadruple therapy, widely used for Helicobacter pylori infection, often ends up in failure due to antibiotic resistance and poor compliance in Korea. Our aim is to evaluate the efficacy and tolerability of moxifloxacin-based triple therapy as an alternative second-line treatment for H. pylori infection. The subjects consisted of 85 patients infected with H. pylori, in whom initial proton pump inhibitor triple therapy had failed. They were randomized to receive the following 7-day therapy: 1, moxifloxacin 400 mg q.d., esomeprazole 20 mg b.i.d., and amoxicillin 1 g b.i.d.; and 2, esomeprazole 40 mg b.i.d., tripotassium dicitrate bismuthate 300 mg q.i.d., metronidazole 500 mg t.i.d., and tetracycline 500 mg q.i.d. Eradication rates, drug compliance, and side-effect rates of each group were evaluated. The eradication rates were 75.6 and 83.8% with moxifloxacin triple therapy, and 54.5 and 72.7% with quadruple therapy by intention-to-treat (p = .042) and per-protocol analyses (p = .260), respectively. Moxifloxacin triple therapy was significantly superior to quadruple therapy in terms of side-effect rates (p = .039). Compliance for therapy, i.e., the percentage of tablets taken (> 85%), was 90.2 and 75.0%, numerically higher in moxifloxacin triple therapy group than in quadruple therapy group, but without statistical difference (p = .065). Moxifloxacin-based triple therapy showed high eradication rates with few side effects and good drug compliance, suggesting this regimen could be a safe and effective option as second-line therapy for H. pylori infection in Korea.