Alimentary TractEfficacy of four different moxifloxacin-based triple therapies for first-line H. pylori treatment☆
Introduction
The current first-line treatment for H. pylori infection implies the use of a PPI with two antibiotics, clarithromycin and amoxicillin, or metronidazole in association with clarithromycin or amoxicillin. The recent consensus conference on this issue in Europe has suggested that clarithromycin should be used in areas where resistance rate is less than 15–20% of tested strains and less than 40% for metronidazole [1]. These guidelines are also followed in Italy as indicated by the Cervia II Working Group Report [2]. In addition, the Italian group recommends using a 14-day triple therapy with clarithromycin and metronidazole as a first-line approach where the prevalence of clarithromycin resistance is >15–20%. A sequential therapy as first-line treatment is also suggested due to the evidence of high eradication rate even in the case of clarithromycin resistance [3]. To overcome antibiotic resistance it is also reasonable to search for new antibiotics with a high sensitivity for H. pylori. In this search three main points should be taken into consideration. The first is the necessity to study and monitor antibiotic resistance in local areas, the second is the necessity to find new antibiotics with a lower resistance than clarithromycin and metronidazole, and the third is to find the proper dosage of the newly identified antibiotic for an optimal therapeutic outcome. Primary resistance of H. pylori of strains collected from patients who have never been treated in the past for H. pylori infection to fluoroquinolones has been reported to be lower than that of clarithromycin in several geographic areas [4]. In a previous study [5] we showed that in our geographical area the resistance rate to levofloxacin and moxifloxacin is between 10% and 12%, with a slightly lower percentage for moxifloxacin in comparison with levofloxacin [6]. In this area clarithromycin resistance is present in about 20% of the strains cultured from patients never treated for the infection [7]. Several papers have been published on triple therapy that include levofloxacin [8], [9] or moxifloxacin [10], [11], [12], [13], [14] as a first-line therapy in patients infected by H. pylori. Dosages and length of treatment have not been standardized yet, and the results of these trials describe contrasting results with eradication rates ranging from 40% to 90% of treated cases. The aim of the study was to evaluate the therapeutic efficacy of an association of moxifloxacin, amoxicillin and proton pump inhibitors (PPI) in four different regimens, in previously untreated patients infected by H. pylori.
Section snippets
Materials and methods
The study was carried out from June 2006 to August 2008 as a randomized, open label, comparative clinical trial with four groups of patients.
Results
Ninety-four, 102, 98 and 105 patients were recruited in groups EAM800 × 10, EAM800 × 7, EAM800 × 5, and EAM400 × 10 respectively. Four patients in the EAM800 × 10 group, five patients in the EAM800 × 7 group, four patients in the EAM800 × 5 group, and six patients in the EAM400 × 10 group did not return for the control. The drug acceptance was good, and almost all patients were able to complete the study. Drop outs included one patient in the EAM800 × 7 group and one patient in the EAM800 × 5 group who interrupted
Discussion
This study shows that a triple therapy that includes amoxicillin, moxifloxacin and esomeprazole may be successfully used for first-line treatment of H. pylori infection with an eradication rate of up to 94%. It is also shown that the optimal dosage and length of treatment of moxifloxacin is 400 mg twice daily for a period of 10 days.
Moxifloxacin has already been used in the first-line treatment of H. pylori infection with variable success. The first reports published by Di Caro et al. [8] showed
Conflict of interest
None declared.
Acknowledgment
The authors thank Mrs. Catherine Hlywka for reviewing the English style of the manuscript.
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Two-week, high-dose proton pump inhibitor, moxifloxacin triple Helicobacter pylori therapy after failure of standard triple or non-bismuth quadruple treatments
2015, Digestive and Liver DiseaseCitation Excerpt :Moxifloxacin is a second-generation fluoroquinolone with a broad spectrum of activity compared with the first generation [16]. Initially, the combination of a PPI, amoxicillin, and moxifloxacin as the first-line regimen was associated with favourable results [23–29]. Later on, other authors studied this same regimen in patients with one previous eradication failure (standard triple therapy) and reported variable results [30–34], with eradication rates ranging from 67% to 76%.
Ideal treatment for Helicobacter pylori: A systematic review
2014, Revista de Gastroenterologia de MexicoBismuth, moxifloxacin, tetracycline, lansoprazole quadruple first line therapy for eradication of H.pylori: A prospective study
2013, Clinics and Research in Hepatology and GastroenterologyCitation Excerpt :There are limited data about its use in the first-line eradication treatment of H. pylori. Overall, the current literature concludes that moxifloxacine-based triple therapies are effective and may be considered as an alternative to standard triple therapies [5,11,12]. However, two studies were inconsistent with the current literature and revealed that moxifloxacine- containing triple therapies had neither eradication nor compliance advantages over standard triple therapies [6,10].
Intensified regimen containing rifampicin and moxifloxacin for tuberculous meningitis: An open-label, randomised controlled phase 2 trial
2013, The Lancet Infectious DiseasesCitation Excerpt :A higher dose of moxifloxacin (800 mg), which might be more potent, led to an almost proportional increase in drug concentrations in the plasma and cerebrospinal fluid. Increasing the dose of rifampicin and moxifloxacin did not seem to greatly increase toxicity, which is in agreement with data for the use of a higher dose of rifampicin for tuberculosis9 and other indications and with the few data available for high-dose moxifloxacin.17,28 Although our study was not powered to detect a difference in mortality, high-dose intravenous rifampicin, when given for the first 2 weeks, led to a roughly 50% reduction in 6 month mortality.
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Part of this study has been presented at the AGA meeting at San Diego (CA, USA), May 17–22, 2008 and has been published in abstract form on Gastroenterology 2008;134:A-24(Suppl. 1).