TEN-DAY VERSUS 14 DAYS LEVOFLOXACIN-CONTAINING TRIPLE THERAPY FOR

SECOND-LINE ANTI-HELICOBACTER PYLORI ERADICATION IN TAIWAN

Wei Chen Tai, Chien Hua Chiu, Chih Ming Liang et.al

Hindawi Publishing Corporation Gastroenterology Research and Practice

Volume 2013 1

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INTRODUCTION

H.Pylori GI disease

Peptic ulcer

Gastric adeno Ca

MALToma

The Maastricht IV/

Florence

Standar therapy

1st line

PPIClarithromycin

Either amoxicilin or

metronidazole

7-14 days

Bismuth-containing quadruple therapy is also alternative

important

deciding

containing triple therapy recomended by the Maastricht IV/ Florence Consensus

neither 7

nor 10 days

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INTRODUCTION

Antibiotic resistance

2nd line therapyH.Pylori

Antibiotic resistance Quinolone

Large meta analysis

Fluorquinolon-based

Tripe therapy> 90% succes

Reports of 2nd line eradication using 14-days levlofloxacin-containing triple therapy are few

Failed eradication 7 days using ( PPI twice daily, 500mg INCLUDED clarithromycin twice daily. 1gr amoxicillin twice daily

at least 18 years of ages

received endoscopic exam which showed ulcers disease or gastritis

Failure confirmed by a positive results for both the rapid urease test and histology after 1st line eradications

EXCLUSION ingestion of antibiotics, bismuth, or PPI within 4 week

allergic history to the medication use

previous gastric surgery

the coexistence od serious concomitant illness (e.g decompensated liver cirrhosis and uremia )

pregnancy

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MATERIAL AND METHODS

200 H.pylori infected

Patient were follow up for the adverse effect and drug compliance after finished the medication

all patient received either an endoscopy or urea breath test 8 weeks later, and also a back up of urea breath test to avoid any false-negative results

poor compliance was defined as that the patient failed to finish 80% all medications due to advers effect

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MATERIAL AND METHODS

10 days Levofloxacin 500mg once daily, amoxicillin 1gr twice daily,

esomeprazole 40mg twice daily( EAL-10)

14 days Levofloxacin 500mg once daily, amoxicillin 1gr twice daily,

esomeprazole 40mg twice daily( EAL-14)

200 patients

1.Rapid Urea Test : involved the collection of gastric antrum biopsy specimens by endoscopy, which were tested using agar base enriched with 40% urea solution (eUAB,Oxoid) and a commercial rapid urase

(Pronto Dry, Medical Instrument Corp,Switzerland) (+) if the colour changed into pink or red when examined after 1 hour

2. Urea Breath Test : the cut-off value was set at 4.8% of δ13 CO2

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MATERIAL AND METHODS

Diagnosis of Helicobacter pylori Infection

Using the SPSS version 18, the chi-square test with or without Yate’s correction for continuity and Fisher’s exact test were used to compare the major outcomes between groups

Eradication rates were analyzed both by Intention-to-treat ( ITT ) and per control (PP) aproach

A P value < 0.05 was considered statistically significant

Univariate and multivariate were used to analyze the independent factor

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MATERIAL AND METHODS

Statistical Analysis

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RESULTS

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RESULTS

None of the variable showed significant difference between EAL-10 & EAL-14

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RESULTS

Abdominal pain, constipation, diarrhea, dizziness, headache, nausea/vomiting, skin rash

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RESULTS

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RESULTS

Quinolone-containing therapy is one of the recomended second-line therapies after the failure of the standard first-line empirical clarithromycin-containing therapy,with bismuth-containing quadruple therapy as an alternate

Large meta analysis with fluorquinolone-containing triple therapy shown that 7 to 10 days of therapy could’t provide 90% or better treatment success

A Levofloxacin-containing triple therapy is simple and well tolerated and has high compliance low adverse effect

in vitro, levofloxacin retains its activity even in dual H.pylori resistent strain to clarithromycin and metonidazole

There is an in vivo synergistic effect of the quinolone and PPI on strains of H.pylori13

DISCUSSION

Gisbert et al :

levofloxacin triple scheme was superior to quadruple therapy ( 81%vs 70% ) with a lower insidence of side effects ( 19% vs 44 % )

Today, quinolone resistace become a major concern for EAL therapy

Kuo et.al

levofloxacine resistent strain was found in 28.3% of patient.

In the current study show that the lenght of H.pylori was the clinical factor influencing the efficacy of eradication

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DISCUSSION

Two recently published study reported that extended the length of quinolone-containing triple therapies to 14 days could achieve eradication success up to 95% (moxifloxacin) and 93.6% (levofloxacin)

The current study achieved an eradication rate 92.5% in EAL-14 group in PP analysis but only 75.6% in EAL-10 group.

This study also show that 14 days should be the optimal length of treatment for quinolone-containing triple therapies as a second-line H.pylori treatment option

quinolone resistance is carefully monitored

The current study encountered it’s limitation.Since our laboratory couldn’t perform CYP2C19 genotyping we used an esomeprazole based regimen,because it’s minimal first-pass metabolism and had a greater gastric acid suppression effect than omeprazole

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DISCUSSION

A 14-days levofloxacin-containing triple therapy can provide >90% H.pylori eradication rate,but 10-day treatment may be suboptimal.

The longer duration is the independent risk factor for eradication

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CONCLUSIONS