Asian Pacific Journal of Cancer Prevention

Asian Pacific Journal of Cancer Prevention (아시아태평양암예방학회)
권호 표지
DOI QR코드

DOI QR Code

High Efficacy of Levofloxacin-Dexlansoprazole-Based Quadruple Therapy as a First Line Treatment for Helicobacter pylori Eradication in Thailand

  • Published : 2015.06.03
Download PDF
⟨ Previous Next ⟩

Abstract

Background: Levofloxacin is an effective medication for second line Helicobacter pylori (H. pylori) eradication. However, limited studies have approved its use as an effective antibiotic in first line therapy. Dexlansoprazole is a new PPI and lacks of evidence in support of a role in H. pylori eradication. This study was designed to evaluate efficacy of levofloxacin-dexlansoprazole-based quadruple therapy for H. pylori eradication in Thailand. Materials and Methods: This prospective randomized control study was performed during June 2014 to December 2014. H. pylori infected gastritis patients were randomized to receive 7- or 14-day levofloxacin-dexlansoprazole based on quadruple therapy (levofloxacin 500 mg OD, dexlansoprazole 60 mg bid, clarithromycin MR 1000 mg OD, bismuth subsalicylate 1048 mg bid). CYP2C19 genotyping and antibiotic susceptibility tests were conducted for all patients. A 13C urea breath test was performed to confirm H. pylori eradication at least 4 weeks after treatment. Results: A total of 100 patients were enrolled, comprising 44 males and 56 females (mean age of 52.6 years). Eradication rate by PP analysis was 85.7% (42/49) with the 7-day regimen and 98% (48/49) with the 14-day regimen (85.7% vs 98%; p-value=0.059). ITT analysis was 84% and 96% with 7- and 14-day regimens, respectively (84% vs 96%; p-value=0.092). Antibiotic susceptibility testing demonstrated 35.1% resistance to metronidazole, 18.3% to clarithromycin, and 13.5% to levofloxacin. CYP2C19 genotyping revealed 54.1% RM, 34.7% IM and 11.2% PM. The 14-day regimen provided 100% eradication in patients with clarithromycin or dual clarithromycin and metronidazole H. pylori resistant strains. Moreover, the eradication rate was 96.6% in patients with CYP2C19 genotype RM. Conclusions: The 14-day levofloxacin-dexlansoprazole based quadruple therapy provides high H. pylori eradication regardless of CYP2C19 genotype, clarithromycin or dual clarithromycin and metronidazole resistant strains. This regimen could be use as an alternative first line therapy for H. pylori eradication in Thailand.

Keywords

References

  1. Antos D, Schneider-Brachert W, Bastlein E, et al (2006). 7-day triple therapy of Helicobacter pylori infection with levofloxacin, amoxicillin, and high-dose esomeprazole in patients with known antimicrobial sensitivity. Helicobacter, 11, 39-45. https://doi.org/10.1111/j.0083-8703.2006.00375.x
  2. Basiri Z, Safaralizadeh R, Bonyadi MJ, et al (2014). Helicobacter pylori vacA d1 genotype predicts risk of gastric adenocarcinoma and peptic ulcers in northwestern Iran. Asian Pac J Cancer Prev, 15, 1575-9. https://doi.org/10.7314/APJCP.2014.15.4.1575
  3. Bayerdorffer E, Neubauer A, Rudolph B, et al (1995). Regression of primary gastric lymphoma of mucosa-associated lymphoid tissue type after cure of Helicobacter pylori infection. MALT Lymphoma Study Group. Lancet, 345, 1591-94. https://doi.org/10.1016/S0140-6736(95)90113-2
  4. Chey WD, Wong BC (2007). American College of Gastroenterology guideline on the management of Helicobacter pylori infection. Am J Gastroenterol, 102, 1808-25. https://doi.org/10.1111/j.1572-0241.2007.01393.x
  5. de Martel C, Ferlay J, Franceschi S, et al (2012). Global burden of cancers attributable to infections in 2008: a review and synthetic analysis. Lancet Oncol, 13, 607-15. https://doi.org/10.1016/S1470-2045(12)70137-7
  6. Demirel BB, Akkas BE, Vural GU (2013). Clinical factors related with Helicobacter pylori infection--is there an association with gastric cancer history in first-degree family members? Asian Pac J Cancer Prev, 14, 1797-802. https://doi.org/10.7314/APJCP.2013.14.3.1797
  7. Fock KM, Katelaris P, Sugano K, et al (2009). Second asiapacific consensus guidelines for Helicobacter pylori infection. J Gastroenterol Hepatol, 24, 1587-600. https://doi.org/10.1111/j.1440-1746.2009.05982.x
  8. Ford AC, Forman D, Hunt RH, et al (2014). Helicobacter pylori eradication therapy to prevent gastric cancer in healthy asymptomatic infected individuals: systematic review and meta-analysis of randomised controlled trials. BMJ, 348, 3174. https://doi.org/10.1136/bmj.g3174
  9. Ford AC, Malfertheiner P, Giguere M, et al (2008). Adverse events with bismuth salts for Helicobacter pylori eradication: systematic review and meta-analysis. World J Gastroenterol, 14, 7361-70. https://doi.org/10.3748/wjg.14.7361
  10. Gisbert JP, Morena F (2006). Systematic review and metaanalysis: levofloxacin-based rescue regimens after Helicobacter pylori treatment failure. Aliment Pharmacol Ther, 23, 35-44. https://doi.org/10.1111/j.1365-2036.2006.02737.x
  11. Graham DY (2009). Efficient identification and evaluation of effective Helicobacter pylori therapies. Clin Gastroenterol Hepatol, 7, 145-8. https://doi.org/10.1016/j.cgh.2008.10.024
  12. Graham DY, Lu H, Yamaoka Y (2007). A report card to grade Helicobacter pylori therapy. Helicobacter, 12, 275-8. https://doi.org/10.1111/j.1523-5378.2007.00518.x
  13. Graham DY, Shiotani A (2012). Which Therapy for Helicobacter pylori Infection? Gastroenterology, 143, 10-12. https://doi.org/10.1053/j.gastro.2012.05.012
  14. Liao J, Zheng Q, Liang X, et al (2013). Effect of fluoroquinolone resistance on 14-day levofloxacin triple and triple plus bismuth quadruple therapy. Helicobacter, 18, 373-7. https://doi.org/10.1111/hel.12052
  15. Mahachai V, Sirimontaporn N, Tumwasorn S, Vilaichone RK (2011). Sequential therapy in clarithromycin-sensitive and -resistant Helicobacter pylori based on polymerase chain reaction molecular test. J Gastroenterol Hepatol, 26, 825-8. https://doi.org/10.1111/j.1440-1746.2011.06660.x
  16. Marshall BJ, Warren JR (1984). Unidentified curved bacilli in the stomach of patients with gastritis and peptic ulceration. Lancet, 1, 1311-5.
  17. Miehlke S, Krasz S, Schneider-Brachert W, et al (2011). Randomized trial on 14 versus 7 days of esomeprazole, moxifloxacin, and amoxicillin for second-line or rescue treatment of Helicobacter pylori infection. Helicobacter, 16, 420-6. https://doi.org/10.1111/j.1523-5378.2011.00867.x
  18. Parsonnet J, Friedman GD, Vandersteen DP, et al (1991). Helicobacter pylori infection and the risk of gastric carcinoma. N Engl J Med, 325, 1127-31. https://doi.org/10.1056/NEJM199110173251603
  19. Rauws EA, Tytgat GN (1990). Cure of duodenal ulcer associated with eradication of Helicobacter pylori. Lancet, 335, 1233-5. https://doi.org/10.1016/0140-6736(90)91301-P
  20. Srinarong C, Siramolpiwat S, Wongcha-um A, Mahachai V, Vilaichone RK (2014). Improved eradication rate of standard triple therapy by adding bismuth and probiotic supplement for Helicobacter pylori treatment in Thailand. Asian Pac J Cancer Prev, 15, 9909-13. https://doi.org/10.7314/APJCP.2014.15.22.9909
  21. Vilaichone RK, Mahachai V (2001). Current management of Helicobacter pylori infection. J Med Assoc Thai, 84, 32-38.
  22. Vilaichone RK, Mahachai V, Graham DY (2006). Helicobacter pylori diagnosis and management. Gastroenterol Clin North Am, 35, 229-47. https://doi.org/10.1016/j.gtc.2006.03.004

Cited by

  1. Seven-Day Bismuth-based Quadruple Therapy as an Initial Treatment for Helicobacter pylori Infection in a High Metronidazole Resistant Area vol.16, pp.14, 2015, https://doi.org/10.7314/APJCP.2015.16.14.6089
  2. Antibiotic Resistant Pattern of Helicobacter Pylori Infection Based on Molecular Tests in Laos vol.17, pp.1, 2016, https://doi.org/10.7314/APJCP.2016.17.1.285
  3. Effect of IL-1 Polymorphisms, CYP2C19 Genotype and Antibiotic Resistance on Helicobacter pylori Eradication Comparing Between 10-day Sequential Therapy and 14-day Standard Triple Therapy with Four-Times-Daily-Dosing of Amoxicillin in Thailand: a Prospective Randomized Study vol.17, pp.4, 2016, https://doi.org/10.7314/APJCP.2016.17.4.1903
  4. The role of dexlansoprazole modified-release in the management of gastroesophageal reflux disease vol.10, pp.2, 2017, https://doi.org/10.1177/1756283X16681701