Individuals colonized with Helicobacter pylori (H. pylori) are at greater risk of developing peptic ulcers, gastric cancer, MALT lymphoma, anemia and vitamin B12 deficiency. Until now, clarithromycin-containing standard triple therapy has been the recommended first-line therapy. However increasing clarithromycin resistance now requires other effective first-line therapies. A recent prospective single-center study investigated the efficacy and safety of the new-generation PPI ilaprazole (10 mg bid), plus levofloxacin (500 mg bid), and amoxicillin (1000 mg bid) for 10 days as a first-line treatment for H. pylori infection.

84 patients with gastric ulcer, duodenal ulcer and gastritis with confirmed H. pylori infection were recruited; 4 dropped out due to reduced compliance. There were no significant laboratory changes after H. pylori eradication. The eradication rate was 84.5% (95% CI: 65.8–106.5%) in the intention-to-treat (ITT) group and 88.8% (95% CI: 69.3–112.0%) in the per protocol (PP) group. Therefore eradication with this regimen was much higher than that reported for levofloxacin-bismuth (LBT) plus omeprazole or lansoprazole (72–83%) and was comparable to LBT plus esomeprazole (87–96%). The researchers noted that this was suggestive of a unique action by ilaprazole compared with other PPIs.

Demographic factors including age, gender, alcohol consumption, smoking status, hypertension, diabetes and liver disease did not affect the eradication rate. However PP analysis and multiple regression analysis showed that patients with normal BMI had higher eradication rates compared to overweight patients (95.6% versus 78.8%) and those with cerebrovascular accident had a lower eradication rate. The incidence of adverse reactions－most commonly nausea, vomiting, and dizziness－was 7.5%.

The researchers concluded that ilaprazole, levofloxacin, and amoxicillin treatment regimen is a safe and a valuable alternative first-line therapy for H. pylori eradication.

PMID: 28539935

Gastroenterol Res Pract. 2017;2017:1654907. doi: 10.1155/2017/1654907. Epub 2017 Apr 28.

Source:https://www.ncbi.nlm.nih.gov/pubmed/28539935?dopt=Abstract