Brief Article
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World J Gastroenterol. Aug 28, 2012; 18(32): 4386-4390
Published online Aug 28, 2012. doi: 10.3748/wjg.v18.i32.4386
Quadruple therapy with moxifloxacin and bismuth for first-line treatment of Helicobacter pylori
Antonio Francesco Ciccaglione, Luigina Cellini, Laurino Grossi, Leonardo Marzio
Antonio Francesco Ciccaglione, Laurino Grossi, Leonardo Marzio, Digestive Physiopathology Unit, Gabriele d'Annunzio University, Pescara Civic Hospital, 65124 Pescara, Italy
Luigina Cellini, Department of Drug Sciences, Gabriele d'Annunzio University, 66013 Chieti, Italy
Author contributions: Ciccaglione AF contributed to the design and set up of the study, analysed and interpreted the data and wrote the draft manuscript; Cellini L contributed substantially to the acquisition of data for the study; Grossi L contributed substantially to the recruitment of patients; Marzio L contributed to the concept, administrative support and overall supervision of the study, analysed the data and critically revised the manuscript.
Correspondence to: Leonardo Marzio, Professor, Digestive Physiopathology Unit, Gabriele d'Annunzio University, Pescara Civic Hospital, Via Fonte Romana 8, 65124 Pescara, Italy. marzio@unich.it
Telephone: +39-85-4252692 Fax: +39-85-4295547
Received: June 6, 2012
Revised: July 20, 2012
Accepted: July 28, 2012
Published online: August 28, 2012
Abstract

AIM: To compare triple therapy vs quadruple therapy for 10 d as first-line treatment of Helicobacter pylori (H. pylori) infection.

METHODS: Consecutive H. pylori positive patients never treated in the past for this infection were randomly treated with triple therapy of pantoprazole (PAN) 20 mg bid, amoxicillin (AMO) 1 g bid and moxifloxacin (MOX) 400 mg bid for 10 d (PAM) or with quadruple therapy of PAN 20 mg bid, AMO 1 g bid, MOX 400 mg bid and bismuth subcitrate 240 mg bid for 10 d (PAMB). All patients were found positive at 13 C-Urea breath test (UBT) performed within ten days prior to the start of the study. A successful outcome was confirmed with an UBT performed 8 wk after the end of treatment. χ2 analysis was used for statistical comparison. Per protocol (PP) and intention-to-treat (ITT) values were also calculated.

RESULTS: Fifty-seven patients were enrolled in the PAM group and 50 in the PAMB group. One patient in each group did not return for further assessment. Eradication was higher in the PAMB group (negative: 46 and positive: 3) vs the PAM group (negative: 44 and positive: 12). The H. pylori eradication rate was statistically significantly higher in the PAMB group vs the PAM group, both with the PP and ITT analyses (PP: PAMB 93.8%, PAM 78.5%, P < 0.02; ITT: PAMB 92%, PAM 77.1 %, P <0.03).

CONCLUSION: The addition of bismuth subcitrate can be considered a valuable adjuvant to triple therapy in those areas where H. pylori shows a high resistance to fluoroquinolones.

Keywords: Helicobacter pylori infection, First-line therapy, Quadruple therapy, Amoxicillin, Moxifloxacin, Bismuth subcitrate