Infection
Update

Quinolones News

#5 May 2, 2017

Levofloxacin-containing concomitant therapy eradicates Helicobacter pylori in patients with type 2 diabetes

Helicobacter pylori (H. pylori) is a major cause of peptic ulcers, gastric cancer, and is associated with an increase in diabetes mellitus development, making effective eradication an important clinical goal.

Clarithromycin-based triple therapy and sequential therapy are widely used as first-line eradication regimens in areas with low rates of clarithromycin resistance. However, the eradication rates achieved by these regimens are poor in patients with diabetes. This study was performed to investigate whether levofloxacin-containing therapy is superior to the standard clarithromycin-based sequential therapy in patients with type 2 diabetes mellitus (T2DM).

114 T2DM patients confirmed to have H. pylori infection were randomized into a clarithromycin-based sequential group (pantoprazole 40 mg, amoxicillin 1000 mg twice daily for the first 5 days, followed by pantoprazole 40mg, clarithromycin 500 mg, and metronidazole 500 mg twice daily for 5 days) or a 10-day levofloxacin-based concomitant group (pantoprazole 40 mg, amoxicillin 1000mg, and metronidazole 500mg twice daily plus levofloxacin 500mg once daily).

The H. pylori eradication rates were significantly higher in the concomitant group than in the sequential group in terms of both ITT analysis (96.4% versus 81.4%, RR: 5.1, 95% CI: 1.19-22.1, p 1⁄4 0.012) and PP analysis (100% versus 85.4%, RR: 1.2, 95% CI: 1.05–1.31, p1⁄4 0.006). The rate of adverse effects was slightly higher in the concomitant group compared to the sequential group (14.5% versus 8.5%), although this was not significant.

The levofloxacin strategy was effective and simple to administer and effective for metronidazole-resistant (21.6%) and dual levofloxacin- and metronidazole-resistant (5.4%) H. pylori isolates in T2DM patients. Researchers concluded that 10 days of levofloxacin-based concomitant therapy appeared to be superior to clarithromycin-based standard sequential therapy for H. pylori eradication in T2DM patients.

PMID: 28266875

Ann Med. 2017 Mar 7:1-8. doi: 10.1080/07853890.2017.1294761.

Source: https://www .ncbi.nlm.nih.gov/pubmed/28266875?dopt=Abstract

 
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