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Comparison between the two drug regimens of PPI+Amoxicillin+Rifampicin and PPI+Amoxicillin+ Levofloxacin for the treatment of H. pylori infections resistant to the first line drug regimen among patients referred to Ilam clinics

Ghobad Abangah, Alireza Raughani, Parisa Asadollahi, Khairollah Asadollahi
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Abstract

Aim: This study compares the effects of two drug regimens for Helicobacter pylori (H. pylori) infection resistant to the first line drug regimen among patients referred to Ilam clinics, Iran.

Background: Single drug regimen is not effective for H. pylori infection and therefore, application of triple or quadruple drug regimens are currently applied.

Methods: This study was performed by a before-after comparative method and patients were randomly selected among those consecutively referred to Ilam gastrointestinal clinics. Patients with failure in the first line treatment, were randomly divided into two equal groups and each group was treated by one of the PPI+Amoxicillin+Rifampicin or PPI+Amoxicillin+Levofloxacin drug regimens for 14 days. Six weeks after treatment, patients were tested for H. pylori stool antigen and the results were compared between two groups.

Results: In this study, 100 patients including 49 (49%) men and 51 (51%) women were examined. There was no statistical difference between the two groups for gender, age and living location at the start of study (p = 0.068). The mean age of the patients was 44.55 ±15.1 years old ranging from 17 to 85 years. Response to treatment among the levofloxacin group, was 90% and in rifampicin group 72% with a significant difference (p<0.04).

Conclusion: The response rate of H. pylori infection to the Levofloxacin based regimen was 90%; however, the application of rifampicin in combination with other drugs against H. pylori infection (72% response rate), should be limited to reduce the possibility of drug resistance in case of tuberculosis infection.

Keywords: Helicobacter pylori, Levofloxacin, Rifampicin, PPI, Drug resistance.

(Please cite as: Abangah GH, Raughani A, Asadollahi P, Asadollahi KH. Comparison between the two drug regimens of PPI+Amoxicillin+Rifampicin and PPI+Amoxicillin+ Levofloxacin for the treatment of H. pylori infections resistant to the first line drug regimen among patients referred to Ilam clinics Gastroenterol Hepatol Bed Bench 2019;12(3):209-216).


Keywords

Helicobacter pylori, levofloxacin, rifampicin, PPI, drug resistance

References

Goh KL, Chan WK, Shiota S, Yamaoka Y. Epidemiology of Helicobacter pylori infection and public health implications. Helicobacter 2011;16:1:1-9.

Malfertheiner P. Diagnostic methods for H. pylori infection: Choices, opportunities and pitfalls. United European Gastroenterol J 2015;3:429-31.

Hu B, El Hajj N, Sittler S, Lammert N, Barnes R, Meloni-Ehrig A. Gastric cancer: Classification, histology and application of molecular pathology. J Gastrointest Oncol 2012;3:251-61.

Hildebrand P, BardhamP, Rossi L, Parvin S, Rahman A, Arefin MS, et al., Recrudescence and Reinfection with helicobacter pylori after eradication therapy in Bangladeshi adults. Gastroenterol 2001; 121:792-8.

Frenck RW Jr, Clemens J. Helicobacter in the developing world. Microbes Infect 2003;5:705-13.

Uemura N, Okamoto S, Yamamoto S, Matsumura N, Yamaguchi S, Yamakido M, et al. Helicobacter pylori infection and the development of gastric cancer. N Engl J Med 2001 13;345:784-9.

Niknam R, Fattahi MR, Sepehrimanesh M, Safarpour A. Prevalence of Helicobacter pylori in Southern Part of Iran. Jundishapur J Microbiol 2018;11:e62379.

Lender N, Talley NJ, Enck P, Haag S, Zipfel S, Morrison M, et al. Review article: Associations between Helicobacter pylori and obesity--an ecological study. Aliment Pharmacol Ther 2014;40:24-31.

Eshraghian A. Epidemiology of Helicobacter pylori infection among the healthy population in Iran and countries of the Eastern Mediterranean Region: a systematic review of prevalence and risk factors. World J Gastroenterol 2014; 20:17618-25.

Aguilar-Luis MA, Palacios-Cuervo F, Espinal-Reyes F, Calderón-Rivera A, Levy-Blitchtein S, Palomares-Reyes C, et al. Highly clarithromycin-resistant Helicobacter pylori infection in asymptomatic children from a rural community of Cajamarca-Peru. BMC Res Notes 2018;11:809.

Chey WD, Wong BC. American College of Gastroenterology guideline on the management of Helicobacter pylori infection. Am J Gastroenterol 2007;102:1808-25.

Diaconu S, Predescu A, Moldoveanu A, Pop CS, Fierbințeanu-Braticevici C. Helicobacter pylori infection: old and new. J Med Life 2017;10:112-7.

Abadi AT, Kusters JG. Management of Helicobacter pylori infections. BMC Gastroenterol 2016;16:94.

Safavi M, Sabourian R, Foroumadi A. Treatment of Helicobacter pylori infection: Current and future insights. World J Clin Cases 2016;4:5-19.

Yang JC, Lu CW, Lin CJ. Treatment of Helicobacter pylori infection: current status and future concepts. World J Gastroenterol 2014;20:5283-93.

Harrison's principles of internal medicine.FauciAS, KasperDL, LongoDL, BraunwaldE, HauserSL, Jameson JLet al. 20th Edition 2019:2447-50

Kuo CH, Hu HM, Kuo FC, Hsu PI, Chen A, Yu FJ, et al. Efficacy of levofloxacin-based rescue therapy for Helicobacter pylori infection after standard triple therapy: a randomized controlled trial. Antimicrob Chemother 2009; 63:1017-24.

Romano M, Cuomo A, Gravina AG, Miranda A, Lovene MR, Tiso A, et al. Empirical Levofloxacin-containing versus Clarithromycin-containing sequential therapy for Helicobacter pylori eradication: a randomized trial. Gut 2010;59:1465-70.

Basu PP, Rayapudik, PacanaI, Shah NJ, Krishnuswamy N, Flynn M. A randomized study comparing levofloxacin, omeprazole, nitazoxanide, and doxycycline versus triple therapy for the eradication of Helicobacter pylori. Am J Gastroenterol 2011;106:1970-5

Gisbert JP, Porez Asia A, Bermejo F, Castro Fernandez M, Almelu P, Barrio J,Cosme A, et al. Second-line therapy with levofloxacin after failure of treatment to eradicate helicobacter pylori infection: time trends in a Spanish Multicenter Study of 1000 patients. J Clin Gastroenterol 2013;47:130-5.

Cammarota G, Cianci R, Cannizzaro O, Cuoco L, Pirozzi G, Gasbarrini A, et al. Efficacy of two one –week rabeprazole /Levofloxacin –based triple therapies for Helicobacter pylori infection. Aliment Pharmacol Ther 2000;14:1339-43.

Perri F, Festa V, Andriulli A. Treatment of antibiotic-resistant Helicobacter pylori infection. N Engl J Med 1998; 339:53.

Heep M, Rieger U, Beck D, Lehn N. Mutations in the beginning of the rpoB gene can induce resistance to rifampicin in both Helicobacter pylori and Mycobacterium tuberculosis. Antimicrob Agents Chemother 2000;44:1075–7.

Hashemi SM, Azali H. The Efficacy of two-Week, Metronidazole, Amoxicillin-Based quadruple Therapy for Eradication of Helicobacter Pylori Infection in Iranian Patients. Razi J Med Sci 2007;14:203-8.

Suerbaum S, Michetti P. Helicobacter pylori infection. N Eng J Med. 2002; 347: 1175-186. 9- Saberi-Firoozi M, Nejabat M. Experiences with Helicobacter pylori treatment in Iran. J Med Sci 2006;31:181-85.

Khalighi AR, Khalighi MR, Ghasemi M, Khalighi N. A Comparison of two Eradicative Regimens (Omeprazole, Clarithromycin, Amoxicillin and Omeprazole, Clarithromycin, Metronidazole) for Helicobacter Pylori Infection in Peptic Ulcer Disease. J Med Sci 2010,5:245-51.

Raoufi R, Rahmanian K, Rajabi J, Zareh F, Matsusher Arani M. Comparison of the effectiveness standard three-drug regimen in the treatment of Helicobacter pylori in a row with the regime in 2011 in the city of Jahrom. NPWJM 2015;2 :177-82.

Shafaghi A, Naghipour M, Haghani S, Amir Maafi A, Rouhi Rad M. Survey on the Eradication of Helicobacter Pylori Infection in Quadruple Therapy:Amoxicillin, Bismuth, Omeprazole and Clarithromycin. Jour Guilin Uni Med sci 2014;23:61-7.

Aminian K, Ghanbari A, Jokar F, Farsad F, Shahrokhi Rad R, Mansoor Ghanaie F. Comparison of three-drug, quadruple, and two different sequential therapies in the first line treatment of Helicobacter pylori infection. J Infect Dis Trop Med 2010:15:7-11

Khalilian A, Karampourian A, Tavakoli M. Determination of effectiveness of four-drug regime in eradication of Helicobacter Pylori (H.Pylori) infection in patients of Hamadan. PSI 2014;12:1-7.

Mendonça S, Ecclissato C, Sartori MS, Godoy AP, Guerzoni RA, Degger M, et al. Prevalence of Helicobacter pylori Ressistance to Metronidazole ,Clarithromycin ,Amoxiciillin, Tetracycline, and Furazolidone in Brazil . Helicobacter 2000;5:79-83.

Ables AZ, Simon I, Melton ER. Update on Helicobacter pylori treatment. Am Fam Physician 2007;75:351-8.

Van der Poorten D, Katelaris PH. The effectiveness of rifabutin triple therapy for patients with difficult-to-eradicate Helicobacter pylori in clinical practice. Aliment Pharmacol Ther 2007;26:1537-42.

Khademi F, Poursina F, Hosseini E, Akbari M, Safaei HG. Helicobacter pylori in Iran: A systematic review on the antibiotic resistance. Iran J Basic Med Sci 2015;18:2-7.

Moradimoghadam F, Khosravi Khorashad A, Mokhtarifar A. Comparison between quadruple therapy and triple therapy for eradication of Helicobacter Pylori in patients with chronic dyspepsia. Horizon Med Sci 2009;14:13-8.

Mantzaris GJ, Petraki K, Archavlis E, Amberiadis P, Christoforidis P, Kourtessas D, et al. Omeprazole triple therapy versus omeprazole quadruple therapy for healing duodenal ulcer and eradication of Helicobacter pylori infection: a 24-month follow-up study. Eur J Gastroenterol Hepatol 2002;14:1237-43.

Catalano F, Catanzaro R, Bentivegna C, Brogna A, Condorelli G, Cipolla R. Ranitidine bismuth citrate versus omeprazole triple therapy for the eradication of Helicobacter pylori and healing of duodenal ulcer .Aliment Pharmacol Ther 1998;12:59-62.

De Francesco V, Zullo A, Hassan C, Faleo D, Ierardi E, Panella C, et al. Two new reatment regimens for Helicobacter pylori eradication: a randomised study. Dig Liver Dis 2001; 33:676-9.

Cianci R, Montalto M, Pandolfi F, Gasbarrini GB, Cammarota G. Third-line rescue therapy for Helicobacter pylori infection. World J Gastroenterol 2006;12:2313-9.

Cammarota G, Martino A, Pirozzi G, Cianci R, Branca G, Nista EC, et al. High efficacy of 1-week doxycycline-and amoxicillin-based quadruple regimen in a culture-guided, third-line treatment approach for Helicobacter pylori infection. Aliment Pharmacol Ther 2004;19:789-95.

Sanaka M, Kuyama Y, Yamanaka M, Iwasaki M. Decrease in serum concentrations of Helicobacter pylori IgG antibodies during antituberculosis therapy: the possible eradication by rifampicin and streptomycin. Am J Gastroenterol 1999;94:1983-4.

Pilotto A, Franceschi M, Rassu M, Furlan F, Scagnelli M. In vitro activity of rifabutin against strains of Helicobacter pylori resistant to metronidazole and clarithromycin. Am J Gastroenterol 2000;95:833-4.

Fujimura S, Kato S, Kawamura T, Watanabe A. In vitro activity of rifampicin against Helicobacter pylori isolated from children and adults. J Antimicrob Chemother 2002;49: 541-3.

Ahuja V, Bhatia V, Dattagupta S, Raizada A, Sharma MP. Efficacy and tolerability of rifampicin-based rescue therapy for Helicobacter pylori eradication failure in peptic ulcer disease. Dig Dis Sci 2005;50:630-6.




DOI: https://doi.org/10.22037/ghfbb.v12i3.1500