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World J Gastroenterol. Apr 21, 2020; 26(15): 1733-1744
Published online Apr 21, 2020. doi: 10.3748/wjg.v26.i15.1733
Update on quinolone-containing rescue therapies for Helicobacter pylori infection
Hideki Mori, Hidekazu Suzuki
Hideki Mori, Department of Clinical and Experimental Medicine, Translational Research Center for Gastrointestinal Disorders, University of Leuven, Leuven 3000, Belgium
Hidekazu Suzuki, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Tokai University School of Medicine, Isehara 259-1193, Japan
Author contributions: All authors equally contributed to this paper with conception and design of the study, literature review and analysis, drafting and critical revision and editing, and final approval of the final version.
Conflict-of-interest statement: During the last 3 years, Suzuki H received scholarship funds for the research from Daiichi-Sankyo Co., EA Pharma Co., Otsuka Pharmaceutical Co. Ltd., and Tsumura Co., and received service honoraria from Astellas Pharma Inc, AstraZeneca K.K., Daiichi-Sankyo Co., EA Pharma Co., Otsuka Pharmaceutical Co. Ltd., Mylan EPD Co., Takeda Pharmaceutical Co., Ltd., Tsumura, Co. and Zeria Pharmaceutical Co. Ltd.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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/
Corresponding author: Hideki Mori, MD, PhD, Doctor, Postdoctoral Fellow, Department of Clinical and Experimental Medicine, Translational Research Center for Gastrointestinal Disorders, University of Leuven, Herestraat 49 Box 701, Leuven 3000, Belgium. hideki.mori@kuleuven.be
Received: December 30, 2019
Peer-review started: December 30, 2019
First decision: February 29, 2020
Revised: March 5, 2020
Accepted: April 4, 2020
Article in press: April 4, 2020
Published online: April 21, 2020
Abstract

Third generation of quinolones, such as levofloxacin and moxifloxacin, -containing regimens are often used in second-line or rescue treatment of Helicobacter pylori infection. However, the increasing antibiotic resistance to quinolones affects the efficacies of quinolones-containing therapies in recent years. Therefore, there is a need to enhance the effectiveness of quinolones-containing therapies. Sitafloxacin, a fourth-generation quinolone, and vonoprazan, a novel potassium-competitive acid blocker, are now available as more effective treatment options. The aim of this paper is to summarize the current evidence of quinolone-containing therapies in rescue treatments, and to discuss the importance of drug sensitivity tests or analysis of gyrA mutation before treatments.

Keywords: Helicobacter pylori, Levofloxacin, Sitafloxacin, Moxifloxacin, gyrA, Vonoprazan

Core tip: The efficacies of 7-d levofloxacin or moxifloxacin, -containing regimens are becoming less effective in recent years due to the increasing antibiotic resistance, which necessitates 10-d or 14-d regimens or bismuth containing regimen are needed to achieve sufficient eradication rates. gyrA mutation is the most sensitive marker for predicting successful eradication in using quinolone-containing therapies. Thus, analysis of gyrA mutation before treatments is recommended. Seven-day sitafloxacin-amoxicillin-vonoprazan triple therapy is the best choice for third-line treatment at present.