Levofloxacin based vs clarithromycin based sequential therapy in helicobacter Pylori eradication; A Randomized Clinical Trial
Gastroenterology and Hepatology from Bed to Bench,
Vol. 11 No. 1 (2018),
6 February 2018
https://doi.org/10.22037/ghfbb.v0i0.1191
Abstract
Aim: This study was aimed to evaluating the efficacy of levofloxacin based sequential therapy vs clarithromycin based sequential therapy in h.pylori (HP) eradication.
Background: Several therapeutic regimen were investigated to treat HP infection. Sequential therapy is an alternative to classic triple therapy.
Methods: In this randomized clinical trial, 200 HP infected patients randomly divided into two therapeutic groups .1-Levofloxacin based sequential regimen (group A); omeprazole and amoxicillin for 7days followed by omeprazole, amoxicillin and levofloxacin for 7days. 2-clarithromycin based sequential regimen (group B): omeprazole and amoxicillin for 7days followed by omeprazole, amoxicillin and clarithromycin for 7days. HP eradication was evaluated with urea breath test with carbon 13 (UBT) 6 weeks after the end of treatment.
Results: Per protocol eradication rates of group A and B were 87.6% and 76% respectively. By intention to treat analysis, eradication rate of group A and B groups were 85.1% and 73% respectively. Levofloxacin based sequential regimen was more effective than clarithromycin based sequential regimen (Pv=0.028).
Adverse events were seen in 19.6% and 15.6% in group A and B respectively. Drug compliance was 97% in group A and 96% in group B. There was no significant difference between two groups in term of adverse events (p=0.470) and compliance (p=0.651).
Conclusion: Levofluxacin based sequential therapy was more effective than Clarithromycin based sequential therapy in HP eradication. The suggested Levofluxacin based sequential therapy could be an alternative therapy in area with high clarithromycin resistance. Further studies are needed to confirm these findings.
Keywords: sequential therapy, Levofluxacin, Clarithromycin, Helicobacter pylori eradication.
(Please cite as: Moradniani M, Mirbeik-Sabzevari Z, Jaferian S, Shafiezadeh SH, Ehsani Ardakani MJ, Mirzaee Roozbahany M, et al. Levofloxacin based vs clarithromycin based sequential therapy in helicobacter pylori eradication; a randomized clinical trial. Gastroenterol Hepatol Bed Bench 2018;11(1):20-26).
- Clarithromycin
- Eradicaction
- Helicobacter pylori
- Levofluxacin
- Sequential therapy
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References
Refrences:
Chey WD, Leontiadis GI, Howden CW, Moss SF. ACG Clinical Guideline: Treatment of Helicobacter pylori Infection. The American Journal of Gastroenterology. 2017.
Selgrad M, Bornschein J, Malfertheiner P. Guidelines for treatment of Helicobacter pylori in the East and West. Expert review of anti-infective therapy. 2011;9(8):581-8.
Zullo A, Rinaldi V, Winn S, Meddi P, Lionetti R, Hassan C, et al. A new highly effective short-term therapy schedule for Helicobacter pylori eradication. Alimentary Pharmacology and Therapeutics. 2000;14(6):715-8.
Jafri NS, Hornung CA, Howden CW. Meta-analysis: sequential therapy appears superior to standard therapy for Helicobacter pylori infection in patients naive to treatment. Annals of Internal Medicine. 2008;148(12):923-31.
Vaira D, Zullo A, Vakil N, Gatta L, Ricci C, Perna F, et al. Sequential Therapy versus Standard Triple-Drug Therapy for Helicobacter pylori EradicationA Randomized Trial. Annals of Internal Medicine. 2007;146(8):556-63.
Kale‐Pradhan PB, Mihaescu A, Wilhelm SM. Fluoroquinolone Sequential Therapy for Helicobacter pylori: A Meta‐analysis. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy. 2015;35(8):719-30.
Malfertheiner P, Megraud F, O'morain CA, Atherton J, Axon AT, Bazzoli F, et al. Management of Helicobacter pylori infection—the Maastricht IV/Florence consensus report. Gut. 2012;61(5):646-64.
De Francesco V, Giorgio F, Hassan C, Manes G, Vannella L, Panella C, et al. Worldwide H. pylori antibiotic resistance: a systematic. J Gastrointestin Liver Dis. 2010;19(4):409-14.
Khademi F, Poursina F, Hosseini E, Akbari M, Safaei HG. Helicobacter pylori in Iran: A systematic review on the antibiotic resistance. Iranian journal of basic medical sciences. 2015;18(1):2.
Gatta L, Vakil N, Vaira D, Scarpignato C. Global eradication rates for Helicobacter pylori infection: systematic review and meta-analysis of sequential therapy. BMj. 2013;347:f4587.
Liou J-M, Chen C-C, Chen M-J, Chen C-C, Chang C-Y, Fang Y-J, et al. Sequential versus triple therapy for the first-line treatment of Helicobacter pylori: a multicentre, open-label, randomised trial. The Lancet. 2013;381(9862):205-13.
Romano M, Cuomo A, Gravina AG, Miranda A, Iovene MR, Tiso A, et al. Empirical levofloxacin-containing versus clarithromycin-containing sequential therapy for Helicobacter pylori eradication: a randomised trial. Gut. 2010;59(11):1465-70.
MOLINA‐INFANTE J, Perez‐Gallardo B, Fernandez‐Bermejo M, Hernandez‐Alonso M, Vinagre G, Duenas C, et al. Clinical trial: clarithromycin vs. levofloxacin in first‐line triple and sequential regimens for Helicobacter pylori eradication. Alimentary pharmacology & therapeutics. 2010;31(10):1077-84.
Gatta L, Vakil N, Leandro G, Di Mario F, Vaira D. Sequential therapy or triple therapy for Helicobacter pylori infection: systematic review and meta-analysis of randomized controlled trials in adults and children. The American journal of gastroenterology. 2009;104(12):3069-79.
Qian J, Ye F, Zhang J, Yang YM, Tu HM, Jiang Q, et al. Levofloxacin‐containing Triple and Sequential Therapy or Standard Sequential Therapy as the First Line Treatment for Helicobacter pylori Eradication in China. Helicobacter. 2012;17(6):478-85.
Graham DY, Lee S-Y. How to effectively use bismuth quadruple therapy: the good, the bad, and the ugly. Gastroenterology clinics of North America. 2015;44(3):537-63.
Villoria A, Garcia P, Calvet X, Gisbert J, Vergara M. Meta‐analysis: high‐dose proton pump inhibitors vs. standard dose in triple therapy for Helicobacter pylori eradication. Alimentary pharmacology & therapeutics. 2008;28(7):868-77.
McNicholl A, Linares P, Nyssen O, Calvet X, Gisbert J. Meta‐analysis: esomeprazole or rabeprazole vs. first‐generation pump inhibitors in the treatment of Helicobacter pylori infection. Alimentary pharmacology & therapeutics. 2012;36(5):414-25.
Choi HS, Park DI, Hwang SJ, Park JS, Kim HJ, Cho YK, et al. Double‐Dose, New‐Generation Proton Pump Inhibitors Do Not Improve Helicobacter pylori Eradication Rate. Helicobacter. 2007;12(6):638-42.
Dubreuil L, Devos J, Beerens H, Romond C. In vitro activity of an ofloxacin-metronidazole combination against anaerobic bacteria. Kinetics of the action of metronidazole against Bacteroides fragilis. Pathologie-biologie. 1988;36(5):488-92.
Wu W, Yang Y, Sun G. Recent insights into antibiotic resistance in Helicobacter pylori eradication. Gastroenterology research and practice. 2012;2012.
Fallahi G-H, Maleknejad S. Helicobacter pylori culture and antimicrobial resistance in Iran. The Indian Journal of Pediatrics. 2007;74(2):127.
Lee H, Hong SN, Min B-H, Lee JH, Rhee P-L, Lee YC, et al. Comparison of efficacy and safety of levofloxacin-containing versus standard sequential therapy in eradication of Helicobacter pylori infection in Korea. Digestive and Liver Disease. 2015;47(2):114-8.
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