Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 14, 2015; 21(46): 13124-13131
Published online Dec 14, 2015. doi: 10.3748/wjg.v21.i46.13124
Moxifloxacin-containing triple therapy after non-bismuth quadruple therapy failure for Helicobacter pylori infection
Ji Hyun Lim, Dong Ho Lee, Seong Tae Lee, Nayoung Kim, Young Soo Park, Cheol Min Shin, In Sung Song
Ji Hyun Lim, Dong Ho Lee, Seong Tae Lee, Nayoung Kim, Young Soo Park, Cheol Min Shin, In Sung Song, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam 463-707, South Korea
Author contributions: Lim JH and Lee DH designed the research, analyzed and interpreted the data, and drafted the manuscript; Lee ST, Kim N, Park YS, Shin CM and Song IS performed the study, analyzed the data, and helped draft the manuscript; all authors have read and approved the final version to be published.
Institutional review board statement: The study was reviewed and approved by the Ethics Committee of Seoul National University Bundang Hospital, No. B-1302/190-102.
Informed consent statement: The institutional review board waived the requirement for informed consent because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment.
Conflict-of-interest statement: The authors have no competing interests.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dong Ho Lee, MD, Department of Internal Medicine, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam, Gyeonggi-do 463-707, South Korea. dhljohn@yahoo.co.kr
Telephone: +82-31-7877006 Fax: +82-31-7874051
Received: May 7, 2015
Peer-review started: May 11, 2015
First decision: June 19, 2015
Revised: July 6, 2015
Accepted: September 2, 2015
Article in press: September 2, 2015
Published online: December 14, 2015
Processing time: 216 Days and 0.3 Hours
Abstract

AIM: To assess the efficacy of moxifloxacin-containing triple therapy after non-bismuth quadruple therapy failure for Helicobacter pylori (H. pylori) eradication.

METHODS: Between January 2010 and December 2012, we screened individuals who were prescribed non-bismuth quadruple therapy for H. pylori eradication. Among them, a total of 98 patients who failed non-bismuth quadruple therapy received 1-wk or 2-wk moxifloxacin-containing triple therapy (400 mg moxifloxacin once daily, and 20 mg of rabeprazole and 1 g of amoxicillin twice daily). H. pylori status was evaluated using the 13C-urea breath test 4 wk later, after treatment completion. The eradication rates were determined by intention-to-treat and per-protocol analyses.

RESULTS: In total, 60 and 38 patients received 1-wk and 2-wk moxifloxacin-containing triple therapy, respectively. The intention-to-treat and per-protocol eradication rates were 56.7% (95%CI: 45.0-70.0) and 59.6% (95%CI: 46.6-71.7) in the 1-wk group and 76.3% (95%CI: 63.2-89.5) and 80.6% (95%CI: 66.7-91.9) in the 2-wk group (P = 0.048 and 0.036, respectively). All groups had good compliance (95% vs 94.9%). Neither group showed serious adverse events, and the proportions of patients experiencing mild side effects were not significantly different (21.1% vs 13.9%). Clinical factors such as age, sex, alcohol and smoking habits, comorbidities, and presence of gastric or duodenal ulcer did not influence the eradication therapy efficacy. The efficacy of second-line eradication therapy did not differ significantly according to the first-line regimen.

CONCLUSION: Two-week moxifloxacin-containing triple therapy showed better efficacy than a 1-wk regimen after non-bismuth quadruple therapy failure.

Keywords: Helicobacter pylori; Moxifloxacin-based triple; Non-bismuth quadruple; Second-line; Eradication

Core tip: We aimed to compare 1-wk and 2-wk moxifloxacin-containing triple therapies after non-bismuth quadruple therapy failure for Helicobacter pylori (H. pylori) infection, especially in patients from a region known to be associated with a high resistance to antibiotics. The eradication rate of the 2-wk group was significantly higher than that of the 1-wk group (76.3% vs 56.7%, P < 0.05), and the incidence of side effects was similar. Thus, a 2-wk regimen may be a reasonable choice as second-line therapy for the eradication of H. pylori infection after non-bismuth quadruple therapy failure.