The efficacy of levofloxacin-based triple therapy for first-line Helicobacter pylori eradication

Öz

Objectives: Standard triple therapy composed of a proton pump inhibitor, clarithromycin and amoxicillin has been widely preferred for H. pylori eradication in Turkey and World. Alternative therapies are currently under investiga­tion because of an increase in clarithromycin resistance. The aim of this study was to evaluate the efficacy of a levoflox-acin-containing triple therapy. Materials and methods: The study was carried out in 81 H. pylori-infected patients (52 female, 29 male) with nonul-cer dyspepsia. The mean age was found 46.3 ± 13.9. Treatment was indicated with lansoprazol 30 mg b.d., amoxicil-lin 1 g b.d., and levofloxacin 500 mg daily for 7 days. H. pylori status was rechecked by (14)C urea breath test 6-8 weeks after the end of therapy. Results: Totally 81 patients could complete the treat­ment and follow-up protocol. Effectiveness was 68%. The distrib-tions of age, gender and smoking were similar be­tween eradicated and non-eradicated groups (p > 0.05). Conclusion: Seven-day levofloxacin based triple therapy is not very effective in the first-line treatment of H. pylori in-fection. The new treatment modalities should be inves­tigated.

Anahtar Kelimeler

• Levofloxacin, Helicobacter pylori, first-line therapy.

The efficacy of levofloxacin-based triple therapy for first-line Helicobacter pylori eradication

Öz

Amaç: İlk basamak H.pilori eradikasyonunda Türkiye\'de ve Dünya\'da en çok tercih edilen tedavi protokolü pro­ton pompa inhibitörü, klaritromisin ve amoksisilin içeren standart tedavi rejimidir. Ancak artan klaritromisin direnci sebe-biyle alternatif tedavi rejimleri araştırılmaktadır. Ça­lışmamızda standart üçlü tedavi rejimindeki klaritromisin yerine le-vofloksasin getirilmesiyle oluşturulan kombinas­yonun etkinliğini araştırdık. Gereç ve yöntem: Çalışma, H.pilori ile enfekte 52 kadın, 29 erkek, toplam 81 nonülser dispepsi hastasında tamam-landı (yaş ortalaması 46,3 ± 13,9). Tedavide “lansoprazol 30mg 2x1, levofloksasin 500 mg 1x1, amoksisilin 1 gr 2x1” 7 gün verildi. Tedavi bitiminden 6-8 hafta sonra C14 üre-nefes testiyle tedavinin etkinliği kontrol edildi. Bulgular: Hastaların % 68\'inde H.pilori negatifliği sağlan­dı. Eradikasyon sağlanan ve sağlanmayan hasta grupları yaş, sigara ve cinsiyet dağılımı yönünden benzer bulundu (p > 0,05). Sonuç: İlk basamak H.pilori eradikasyonunda 7 gün sü­reyle verilen levofloksasin temelli üçlü tedavi yeterince etkin değildir. Yeni tedavi protokollerine ihtiyaç duyulmak­tadır.

Anahtar Kelimeler

• Helikobakter pilori, levofloksasin, ilk basamak tedavi.

Kaynakça

1. Brown LM. Helicobacter pylori: epidemiology and routes of transmission. Epidemiol Rev 2000;22(3):283-97.
2. Makola Di Peura DA, Crowe SE. Helicobacter pylori infec- tion and related gastrointestinal diseases. J Clin Gastroen- terol 2007;41(4):548-58.
3. Tomita T, Fukuda Y, Tamura K, et al. Successful eradication of Helicobacter pylori prevents relapse of peptic ulcer dis- ease. Aliment Pharmacol Ther 2002;16 (Suppl 2):204-9.
4. Take S, Mizuno M, Ishiki K, et al. Baseline gastric mucosal atrophy is a risk factor associated with the development of gastric cancer after Helicobacter pylori eradication thera- py in patients with peptic ulcer diseases. J Gastroenterol 2007;42 (Suppl 17):21-7.
5. Zullo A, Hassan C, Cristofari F, Perri F, Morini S. Gastric low-grade mucosal-associated lymphoid tissue-lymphoma: Helicobacter pylori and beyond. World J Gastrointest On- col 2010;2(2):181-6.
6. Ağbaba E, Nazlıgül Y, Yeniova AÖ, ve ark. Helikobakter pilo- ri eradikasyonunun fonksiyonel dispepsi semptomları üze- rine kısa dönem etkileri. Dicle Tıp Derg 2010;37(2):211-6.
7. Moayyedi P, Soo S, Deeks J, et al. Systematic review and economic evaluation of Helicobacter pylori eradication tre- atment for non-ulcer dyspepsia. Dyspepsia Review Group BMJ 2000;16;321(5):659-64.
8. Malfertheiner P, Megraud F, O’Morain C, et al. Current con- cepts in the management of Helicobacter pylori infection: the Maastricht III Consensus Report. Gut 2007;56(6):772- 81.

9. Fock KM. Second Asia-Pacific Consensus Guidelines for Helicobacter pylori infection. J Gastroenterol Hepatol 2009;24(11):1587-600.
10. Göral V, Zeyrek FY, Gül K. Helikobakter pilori enfeksiyo- nunda antibiyotik direnci. Türkiye Klin Gastroenterohepa- tol Derg 2000;11(1):87-92.
11. Siavoshi F, Saniee P, Latifi-Navid S, Massarrat S, Sheyk- holeslami A. Increase in resistance rates of H. pylori iso- lates to metronidazole and tetracycline--comparison of three 3-year studies. Arch Iran Med 2010;13(2):177-87.
12. Agudo S, Alarcón T, Cibrelus L, Urruzuno P, Martínez MJ, López-Brea M. [High percentage of clarithromycin and metronidazole resistance in Helicobacter pylori clinical iso- lates obtained from Spanish children]. Rev Esp Quimioter 2009;22(1):88-92.
13. Masuda H, Hiyama T, Yoshihara M, Tanaka S, Haruma K, Chayama K. Characteristics and trends of clarithromycin- resistant Helicobacter pylori isolates in Japan over a de- cade. Pathobiology 2004;71(2):159-63.
14. Sasaki M, Ogasawara N, Utsumi K, et al. Changes in 12- year first-line eradication rate of Helicobacter pylori based on triple therapy with proton pump ınhibitor, amoxicillin and clarithromycin. J Clin Biochem Nutr 2010;47(1):53-8.
15. Kadayifci A, Buyukhatipoglu H, Savas MC, Simsek I. Eradication of Helicobacter pylori with triple therapy: an epidemiologic analysis of trends in Turkey over 10 years. Clin Ther 2006;28(12):1960-6.
16. Altintas E, Sezgin O, Ulu O, Aydin O, Camdeviren H. Maas- tricht II treatment scheme and efficacy of different proton pump inhibitors in eradicating Helicobacter pylori. World J Gastroenterol 2004;10(12):1656-65.
17. Güliter S, Keleş H, Ozkurt ZN, Cengiz DU, Kolukisa E. Can lansoprazole, amoxicillin, and clarithromycin combination still be used as a first-line therapy for eradication of Helico- bacter pylori? Turk J Gastroenterol 2005;16(1):29-33.
18. Göral V, Dönmez M, Temiz H, Şit D. Nonülser dispepside Helikobakter pilori sıklığı ve eradikasyon tedavisine yanıt. Akademik Gastroenteroloji Dergisi 2006;5(2):173-178.
19. Zhang ZF, Zhao G, Liu LN. [Effectiveness and safety of proton pump inhibitor and levofloxacin based first-line tri- ple therapy in the eradication of Helicobacter pylori: a me- ta-analysis] Zhonghua Yi Xue Za Zhi 2008;88(12):2722-5.
20. Cheng H, Hu FL, Zhang GX, et al. [Levofloxacin-based triple therapy for first-line Helicobacter pylori eradication treatment: a multi-central, randomized, controlled clinical study]. Zhonghua Yi Xue Za Zhi 2010;90(1):79-82.
21. Castro-Fernández M, Lamas E, Pérez-Pastor A, et al. Effica- cy of triple therapy with a proton pump inhibitor, levofloxa- cin, and amoxicillin as first-line treatment to eradicate Heli- cobacter pylori. Rev Esp Enferm Dig 2009;101(3):395-8.
22. Schrauwen RW, Janssen MJ, de Boer WA. Seven-day PPI- triple therapy with levofloxacin is very effective for Helico- bacter pylori eradication. Neth J Med 2009;67(1):96-101.
23. Doğan E, Kefeli A, Nazlıgül Y, ve ark. Helicobakter pilori ile enfekte duodenal ülser ve fonksiyonel dispepsi hastala- rında anti-CagA pozitifliği ve eradikasyon tedavi başarısına etkisi. Dicle Tıp Dergisi 2011;38(1):7-11.
24. Gisbert JP, Marcos S, Gisbert JL, Pajares JM. Helicobacter pylori eradication therapy is more effective in peptic ulcer than in non-ulcer dyspepsia. Eur J Gastroenterol Hepatol 2001;13(11):1303-7.
25. Perri F, Villani MR, Festa V, Quitadamo M, Andriulli A. Predictors of failure of Helicobacter pylori eradication with the standard ‘Maastricht triple therapy’. Aliment Pharma- col Ther 2001;15(12):1023-9.
26. Labenz J, Leverkus F, Börsch G. Omeprazole plus amoxi- cillin for cure of Helicobacter pylori infection. Factors influencing the treatment success. Scand J Gastroenterol 1994;29(12):1070-5.
27. Furuta T, Sugimoto M, Shirai N, Ishizaki T. CYP2C19 pharmacogenomics associated with therapy of Helico- bacter pylori infection and gastro-esophageal reflux dis- eases with a proton pump inhibitor. Pharmacogenomics 2007;8(11):1199-210.
28. Hung KH, Sheu BS, Chang WL, Wu HM, Liu CC, Wu JJ. Prevalence of primary fluoroquinolone resistance among clinical isolates of Helicobacter pylori at a University Hos- pital in Southern Taiwan. Helicobacter 2009;14(1):61-5.
29. Bogaerts P, Berhin C, Nizet H, Glupczynski Y. Prevalence and mechanisms of resistance to fluoroquinolones in He- licobacter pylori strains from patients living in Belgium. Helicobacter 2006;11(4):441-5.
30. Erdoğan AF, Abacı K, Serin E, Özer B, İçer MO. Birinci tercih Helikobakter pilori eradikasyon tedavileri alarm mı veriyor? Akademik Gastroenterol Derg 2009;8(1):59-62.