Evidence-Based Medicine
Copyright ©2014 Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 14, 2014; 20(22): 6932-6938
Published online Jun 14, 2014. doi: 10.3748/wjg.v20.i22.6932
Helicobacter pylori eradication with moxifloxacin-containing therapy following failed first-line therapies in South Korea
Kyu Keun Kang, Dong Ho Lee, Dong Hyun Oh, Hyuk Yoon, Cheol Min Shin, Young Soo Park, Nayoung Kim, Hyun Chae Jung
Kyu Keun Kang, Dong Ho Lee, Dong Hyun Oh, Hyuk Yoon, Cheol Min Shin, Young Soo Park, Nayoung Kim, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeongi-do 463-707, South Korea
Hyun Chae Jung, Department of Internal Medicine, Seoul National University College of Medicine, Seoul 100-744, South Korea
Author contributions: Kang KK, Lee DH and Oh DH were responsible for conception, design of the study, analysis and interpretation of data, and wrote the manuscript; Yoon H, Shin CM, Park YS, Kim N and Jung HC critically revised the article for important intellectual content; all the authors reviewed and approved the final version to be published.
Correspondence to: Dong Ho Lee, PhD, Department of Internal Medicine, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeongi-do 463-707, South Korea. dhljohn@yahoo.co.kr
Telephone: +82-31-7877006 Fax: +82-31-7874051
Received: December 12, 2013
Revised: January 8, 2014
Accepted: February 26, 2014
Published online: June 14, 2014
Processing time: 186 Days and 6.4 Hours
Abstract

AIM: To investigate moxifloxacin-containing triple therapy as second-line treatment for Helicobacter pylori (H. pylori) infection following failed first-line treatment.

METHODS: The sample included 312 patients for whom first-line treatment failed between January 2008 and May 2013; 27 patients were excluded, and a total of 285 patients received 7- or 14-d moxifloxacin-containing triple therapy as second-line treatment for H. pylori infection. First line regimens included 7-d standard triple (n = 172), 10-d bismuth-containing quadruple (n = 28), 14-d concomitant (n = 37), or 14-d sequential (n = 48) therapy. H. pylori status was evaluated using 13C-urea breath testing 4 wk later, after completion of the treatment. The primary outcome was the H. pylori eradication rate analyzed using intention-to-treat (ITT) and per protocol (PP) analyses. The secondary outcome was the occurrence of serious adverse events. Demographic and clinical factors were analyzed using Student’s t-tests and Pearson’s χ2 tests according to first- and second-line regimens. A P value of less than 0.05 was considered statistically significant.

RESULTS: The eradication rate of moxifloxacin-containing triple therapy was 68.4% (ITT; 95%CI: 62.8-73.5) and 73.9% (PP; 95%CI: 68.3-78.8). The eradication rate was significantly higher with 14 d compared to 7 d of treatment (77.5% vs 62.5%, P = 0.017). Peptic ulcer patients had a higher eradication rate than the patients without ulcers (82.9% vs 70.6%, P = 0.046). The demographic and clinical characteristics were not significantly different between the groups according to first-line therapies. ITT and PP analyses of the moxifloxacin-containing triple therapy indicated the following eradication rates: 70.9% (95%CI: 63.8-77.2) and 77.2% (95%CI: 70.1-83.1) for standard triple; 67.9% (95%CI: 51.5-84.2) and 67.9% (95%CI: 51.5-84.2) for bismuth-containing quadruple; 60.4% (95%CI: 46.3-73.0) and 70.7% (95%CI: 54.0-80.9) for sequential; and 67.6% (95%CI: 51.5-80.4) and 67.6%(95%CI: 51.5-80.4) for concomitant therapy. There were no statistically significant differences in the efficacy of the first-line regimens (P = 0.492). The most common adverse event was diarrhea. There were no serious adverse events and no significant differences in the frequency of side effects between the first- and second-line regimens (28.7% vs 26.1%, respectively).

CONCLUSION: Moxifloxacin-containing triple therapy as second-line treatment resulted in low eradication rates. There were no differences in the efficacy between the first-line regimens in South Korea.

Keywords: Fluoroquinolones; Helicobacter pylori; Disease eradication; Drug resistance; Second-line

Core tip: This study aimed to examine Helicobacter pylori (H. pylori) eradication rates using moxifloxacin-containing triple therapy as second-line treatment. The effectiveness of the failed first-line treatment options was compared. The use of moxifloxacin-containing triple therapy resulted in low eradication rates, and there were no differences in the efficacy between the failed first-line regimens. As a result, we recommend tailored therapy for H. pylori and careful antibiotic selection before second-line treatment in South Korea.