Infection
Update

Quinolones News

#9 May 2, 2017

Levofloxacin-containing quadruple therapy achieves highest rate of Helicobacter pylori eradication

Helicobacter pylori (H. pylori) infection affects 20-50% of people in industrialised countries and up to 80% in less developed nations, making it a global public health issue. Most guidelines recommend triple therapy but these regimens fail due to increasing resistance, particularly to clarithromycin, resulting in recommendations for bismuth-containing quadruple regimens. Recent studies have shown levofloxacin-containing triple regimens to be effective as first-line triple therapy. This study was performed to investigate the clinical efficacy and safety of two 1-week bismuth-containing quadruple regimens and one levofloxacin-based triple regimen for eradication of H. pylori infection in previously untreated patients. In addition the influence of CYP2C19 polymorphisms was evaluated.

270 patients were randomised to receive either esomeprazole and colloidal bismuth, clarithromycin and amoxicillin (EBCA); esomeprazole and colloidal bismuth, levofloxacin and amoxicillin (EBLA); or esomeprazole, levofloxacin and amoxicillin (ELA) for 1 week.  Eradication rates for EBCA, EBLA or ELA 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. The incidence of adverse events was similar for all groups. Efficacy of the EBLA and ELA regimens were reduced in levofloxacin-resistant H. pylori, but not by polymorphisms of CYP2C19 gene for any of the 3 groups.

The researchers commented that while sequential triple-therapy regimens are gaining in acceptance, the complexity of the administration can result in reduced compliance. They therefore concluded that acceptable eradication is achieved with concomitant regimens of either a one week bismuth-containing quadruple regimen, or levofloxacin-containing triple therapy. Among the regimens tested, levofloxacin-based quadruple therapy achieved the highest eradication rate.

PMID: 28207505

Medicine (Baltimore). 2017 Feb;96(7):e5859. doi: 10.1097/MD.0000000000005859.

Source: https://www.ncbi.nlm.nih.gov/pubmed/2 8207505?dopt=Abstract
 
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