Moxifloxacin-containing triple therapy as second-line treatment for helicobacter pylori infection: Effect of treatment duration and antibiotic resistance on the eradication rate

Hyuk Yoon, Nayoung Kim, Byoung Hwan Lee, Tae Jun Hwang, Dong Ho Lee, Young Soo Park, Ryoung Hee Nam, Hyun Chae Jung, In Sung Song

Research output: Contribution to journalArticle

42 Citations (Scopus)

Abstract

Background and Aim: The aim of this study was to evaluate the efficacy of a moxifloxacin-containing triple therapy as second-line treatment for Helicobacter pylori infection. We also investigated the effect of treatment duration and antibiotic resistance on the eradication rate of this therapy. Methods: We prospectively enrolled patients found to have persistent H. pylori infections after failure of first-line proton-pump inhibitor-based triple therapy. Patients took moxifloxacin (400 mg q.d.), amoxicillin (1000 mg b.i.d.), and esomeprazole (20 mg b.i.d.). The eradication rate, drug compliance, and adverse event rates were evaluated. Minimal inhibitory tests were performed for moxifloxacin and amoxicillin by the agar dilution method. Results: In 2004, 41 patients were treated for 7 days. The intention-to-treat and per-protocol eradication rates (ITT/PP) were 75.6/83.8%. Moxifloxacin resistance was 5.6%. Therapy was extended to 10 days during 2005-2006 and 139 patients were treated. The ITT/PP eradication rates were 71.9/82.6%; moxifloxacin resistance had increased to 12%. The final group of 181 patients in 2007-2008 who were treated for 14 days also had low eradication rates (68/79.9%), but there was no statistical significance in the efficacy among the treatment periods. Moxifloxacin resistance in 2007-2008 was 28.2%. Side-effect increased with treatment duration (i.e., 9.8, 12.2, and 25.4% at 7, 10, and 14 days, respectively, p =.001). Conclusion: The 7-day moxifloxacin-containing triple therapy produced an unacceptably low eradication rate. Increasing the duration of therapy was expected to increase the eradication rate, but the expected increased did not materialize, most likely because of coincident marked increase in the prevalence of resistance to moxifloxacin. Tailored treatment based on antibiotic susceptibility testing might be more effective in the achievement of high eradication rate when rapid antibiotic resistance such as moxifloxacin is occurring.

Original languageEnglish
Pages (from-to)77-85
Number of pages9
JournalHelicobacter
Volume14
Issue number5
DOIs
StatePublished - 1 Oct 2009

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Helicobacter Infections
Microbial Drug Resistance
Helicobacter pylori
Therapeutics
Amoxicillin
Esomeprazole
moxifloxacin
Proton Pump Inhibitors
Drug-Related Side Effects and Adverse Reactions
Compliance
Agar
Anti-Bacterial Agents

Keywords

  • Eradication
  • H. pylori
  • Moxifloxacin
  • Resistance
  • Second-line

Cite this

@article{0d405fc21b6e40cd8bde3bf30c577424,
title = "Moxifloxacin-containing triple therapy as second-line treatment for helicobacter pylori infection: Effect of treatment duration and antibiotic resistance on the eradication rate",
abstract = "Background and Aim: The aim of this study was to evaluate the efficacy of a moxifloxacin-containing triple therapy as second-line treatment for Helicobacter pylori infection. We also investigated the effect of treatment duration and antibiotic resistance on the eradication rate of this therapy. Methods: We prospectively enrolled patients found to have persistent H. pylori infections after failure of first-line proton-pump inhibitor-based triple therapy. Patients took moxifloxacin (400 mg q.d.), amoxicillin (1000 mg b.i.d.), and esomeprazole (20 mg b.i.d.). The eradication rate, drug compliance, and adverse event rates were evaluated. Minimal inhibitory tests were performed for moxifloxacin and amoxicillin by the agar dilution method. Results: In 2004, 41 patients were treated for 7 days. The intention-to-treat and per-protocol eradication rates (ITT/PP) were 75.6/83.8{\%}. Moxifloxacin resistance was 5.6{\%}. Therapy was extended to 10 days during 2005-2006 and 139 patients were treated. The ITT/PP eradication rates were 71.9/82.6{\%}; moxifloxacin resistance had increased to 12{\%}. The final group of 181 patients in 2007-2008 who were treated for 14 days also had low eradication rates (68/79.9{\%}), but there was no statistical significance in the efficacy among the treatment periods. Moxifloxacin resistance in 2007-2008 was 28.2{\%}. Side-effect increased with treatment duration (i.e., 9.8, 12.2, and 25.4{\%} at 7, 10, and 14 days, respectively, p =.001). Conclusion: The 7-day moxifloxacin-containing triple therapy produced an unacceptably low eradication rate. Increasing the duration of therapy was expected to increase the eradication rate, but the expected increased did not materialize, most likely because of coincident marked increase in the prevalence of resistance to moxifloxacin. Tailored treatment based on antibiotic susceptibility testing might be more effective in the achievement of high eradication rate when rapid antibiotic resistance such as moxifloxacin is occurring.",
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Moxifloxacin-containing triple therapy as second-line treatment for helicobacter pylori infection : Effect of treatment duration and antibiotic resistance on the eradication rate. / Yoon, Hyuk; Kim, Nayoung; Lee, Byoung Hwan; Hwang, Tae Jun; Lee, Dong Ho; Park, Young Soo; Nam, Ryoung Hee; Jung, Hyun Chae; Song, In Sung.

In: Helicobacter, Vol. 14, No. 5, 01.10.2009, p. 77-85.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Moxifloxacin-containing triple therapy as second-line treatment for helicobacter pylori infection

T2 - Effect of treatment duration and antibiotic resistance on the eradication rate

AU - Yoon, Hyuk

AU - Kim, Nayoung

AU - Lee, Byoung Hwan

AU - Hwang, Tae Jun

AU - Lee, Dong Ho

AU - Park, Young Soo

AU - Nam, Ryoung Hee

AU - Jung, Hyun Chae

AU - Song, In Sung

PY - 2009/10/1

Y1 - 2009/10/1

N2 - Background and Aim: The aim of this study was to evaluate the efficacy of a moxifloxacin-containing triple therapy as second-line treatment for Helicobacter pylori infection. We also investigated the effect of treatment duration and antibiotic resistance on the eradication rate of this therapy. Methods: We prospectively enrolled patients found to have persistent H. pylori infections after failure of first-line proton-pump inhibitor-based triple therapy. Patients took moxifloxacin (400 mg q.d.), amoxicillin (1000 mg b.i.d.), and esomeprazole (20 mg b.i.d.). The eradication rate, drug compliance, and adverse event rates were evaluated. Minimal inhibitory tests were performed for moxifloxacin and amoxicillin by the agar dilution method. Results: In 2004, 41 patients were treated for 7 days. The intention-to-treat and per-protocol eradication rates (ITT/PP) were 75.6/83.8%. Moxifloxacin resistance was 5.6%. Therapy was extended to 10 days during 2005-2006 and 139 patients were treated. The ITT/PP eradication rates were 71.9/82.6%; moxifloxacin resistance had increased to 12%. The final group of 181 patients in 2007-2008 who were treated for 14 days also had low eradication rates (68/79.9%), but there was no statistical significance in the efficacy among the treatment periods. Moxifloxacin resistance in 2007-2008 was 28.2%. Side-effect increased with treatment duration (i.e., 9.8, 12.2, and 25.4% at 7, 10, and 14 days, respectively, p =.001). Conclusion: The 7-day moxifloxacin-containing triple therapy produced an unacceptably low eradication rate. Increasing the duration of therapy was expected to increase the eradication rate, but the expected increased did not materialize, most likely because of coincident marked increase in the prevalence of resistance to moxifloxacin. Tailored treatment based on antibiotic susceptibility testing might be more effective in the achievement of high eradication rate when rapid antibiotic resistance such as moxifloxacin is occurring.

AB - Background and Aim: The aim of this study was to evaluate the efficacy of a moxifloxacin-containing triple therapy as second-line treatment for Helicobacter pylori infection. We also investigated the effect of treatment duration and antibiotic resistance on the eradication rate of this therapy. Methods: We prospectively enrolled patients found to have persistent H. pylori infections after failure of first-line proton-pump inhibitor-based triple therapy. Patients took moxifloxacin (400 mg q.d.), amoxicillin (1000 mg b.i.d.), and esomeprazole (20 mg b.i.d.). The eradication rate, drug compliance, and adverse event rates were evaluated. Minimal inhibitory tests were performed for moxifloxacin and amoxicillin by the agar dilution method. Results: In 2004, 41 patients were treated for 7 days. The intention-to-treat and per-protocol eradication rates (ITT/PP) were 75.6/83.8%. Moxifloxacin resistance was 5.6%. Therapy was extended to 10 days during 2005-2006 and 139 patients were treated. The ITT/PP eradication rates were 71.9/82.6%; moxifloxacin resistance had increased to 12%. The final group of 181 patients in 2007-2008 who were treated for 14 days also had low eradication rates (68/79.9%), but there was no statistical significance in the efficacy among the treatment periods. Moxifloxacin resistance in 2007-2008 was 28.2%. Side-effect increased with treatment duration (i.e., 9.8, 12.2, and 25.4% at 7, 10, and 14 days, respectively, p =.001). Conclusion: The 7-day moxifloxacin-containing triple therapy produced an unacceptably low eradication rate. Increasing the duration of therapy was expected to increase the eradication rate, but the expected increased did not materialize, most likely because of coincident marked increase in the prevalence of resistance to moxifloxacin. Tailored treatment based on antibiotic susceptibility testing might be more effective in the achievement of high eradication rate when rapid antibiotic resistance such as moxifloxacin is occurring.

KW - Eradication

KW - H. pylori

KW - Moxifloxacin

KW - Resistance

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JO - Helicobacter

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