THE EVALUATION OF TRIPLE, QUADRUPLE, AND LEVOFLOXACIN-BASED THERAPY IN THE MANAGEMENT OF HELICOBACTER PYLORI INFECTION AMONG DYSPEPTIC PATIENTS
Mohammed O. Mohammed a, Dunya M. Arif b and Mohsin A. Mohammed b
a Department of Medicine, College of Medicine, University of Sulaimani.
b Kurdistan Center for Gastroenterology and Hepatology, Sulaimani Directorate of Health.
Submitted: 30/1/2018; Accepted: 27/2/2019; Published 21/3/2019
DOI Link: https://doi.org/10.17656/jsmc.10189
The eradication rate for the first line therapy in H. pylori infection declined worldwide as a result of resistance development; however other therapies as quadruple and levofloxacin-based therapy are also used and have different eradication rate.
To assess the response rate of H. pylori infection for different drug’s regimens (triple, quadruple, and levobased), and evaluate the effect of age, gender, body mass index and compliance of the patients on the regimens response rate.
A cross- sectional study, conducted in Kurdistan Center for Gastroenterology and Hepatology (KCGH) in Sulaimani, from April 2018 –November 2018. The study Included 753 dyspeptic patients, H. pylori were positive in 430 (57.1%) patients. Demographic data, anthropometric measures, and clinical presentations were recorded for the participants. The participants were randomly treated with one of the standard H. pylori eradication regimens (triple, quadruple or levobased), they have been followed up for 45 days and rechecked for H. pylori.
The mean age of the patients was 39.8± 15.6 years, and the mean Body Mass Index was 25.7± 6.1kg/m2, 182(42.3%) were male and 248 (57.7%) were female. The rates of responses were (84.4%, 89.4%, and 97.4%) for the triple, quadruple and levobased regimens respectively. The most adverse effects were dizziness and metallic taste recorded in 30.3% in the quadruple group. Statistically, a significant difference was found in the response rate among the triple, quadruple and levobased regimens (p= 0.033). There were no significant differences in the response rate among the three regimens group regarding age, gender, and body mass index. More than 95% in those who completed follow up were adherent to their regimens.
Triple and quadruple regimens are still effective for H. pylori eradication, but have more adverse effects than levobased regimens. Levobased regimen has highest eradication rate for H. pylori, better compliance, and least adverse effects.
H. pylori, Triple therapy, Quadruple therapy, Levofloxacin based therapy.
1. Kusters JG, van Vliet AH, Kuipers EJ. Pathogenesis of Helicobacter pylori infection. Clin Microbiol Rev. 2006 Jul; 19(3):449-90.
2. Perez-Perez GI, Rothenbacher D, Brenner H. Epidemiology of Helicobacter pylori infection. Helicobacter. 2004; 9 Suppl 1:1-6.
3. Pounder RE, Ng D. The prevalence of Helicobacter pylori infection in different countries. Aliment Pharmacol Ther. 1995; 9 Suppl 2:33-9.
4. Goodman KJ, Correa P. Transmission of Helicobacter pylori among siblings. Lancet. 2000 Jan 29; 355(9201):358-62.
5. Allaker RP, Young KA, Hardie JM, Domizio P, Meadows NJ. Prevalence of Helicobacter pylori at oral and gastrointestinal sites in children: evidence for possible oral-to-oral transmission. J Med Microbiol. 2002 Apr; 51(4):312-7.
6. Ferguson DA Jr, Jiang C, Chi DS, Laffan JJ, Li C, Thomas E. Evaluation of two string tests for obtaining gastric juice for culture, nested-PCR detection, and combined single and double-stranded conformational polymorphism discrimination of Helicobacter pylori.Dig Dis Sci. 1999 Oct;44(10):2056-62.
7. Juli L Fashner, Alfred C. Gitu. Diagnoses and Treatment of Peptic Ulcer Disease and H. pylori Infection. Am Fam Physician. 2015 Feb 15; 91(4):236-242.
8. Talley NJ, Vakil N; Practice Parameters Committee of the American College of Gastroenterology. Guidelines for the management of dyspepsia. Am J Gastroenterol. 2005; 100(10):2324-2337.
9.Shimoyama T. Stool antigen tests for the management of Helicobacter pylori infection. World J Gastroenterol. 2013 Dec 7; 19(45): 8188–8191.
10. Malfertheiner P, Megraud F, O'Morain CA, Atherton J, Axon AT, Bazzoli F, et al. Management of Helicobacter pylori infection-the Maastricht IV/ Florence Consensus.Report.Gut. 2012 May; 61(5):646-64.
11. WD Chey, GI Leontiadis, CW Howden, SF Moss. ACG Clinical Guideline: Treatment of Helicobacter pylori Infection. The American journal of gastroenterology. 2017.112(2):212.
12. Ozdemir E, Karabacak NI, Degertekin B, Cirak M, Dursun A, Engin D et al. Could the simplified (14)C urea breath test be a new standard in noninvasive diagnosis of Helicobacter pylori infection?. 2008 Aug; 22(7):611-6.
13. Cutler AF. Testing for Helicobacter pylori in clinical practice. Am J.Med.1996; 100:35S-41S.
14. Anand BS. Raed AK, Malaty HM, et al.Loe point prevalence of peptic ulcer in a normal individual with Helicobacter pylori infection.Am J Gastroenterol.1996, 91:1112-1115.
15. Abuhammour, Dajani A., Nounou N., Zakaria M. Standard triple therapy versus sequential therapy for eradication of Helicobacter pylori in treatment naïve and retreat patients. AJG. 2016, 17(3): Pages 131-136.
16. Mohammad A. Al Sheikhani, Bnar S. Saida. The Efficacy of Standard Triple anti Helicobacter pylori Therapy in Endoscopy-Proven Duodenal and Gastric Ulcers. JSMC. 2017 7(2):206-210.
17. Atieh Makhlough, Hafez Fakheri, Samaneh Hojati, Vahid Hosseini, and Zohreh Bari. A Comparison between Hybrid Therapy and Standard Triple Therapy for Helicobacter pylori Eradication in Patients with Uremia: A Randomized Clinical Trial. Middle East J Dig Dis. 2016 Jan; 8(1): 39–43.
18. Saracino IM, Zullo A, Holton J, Castelli V, Fiorini G, Zaccaro C, et al. High prevalence of primary antibiotic resistance in Helicobacter pylori isolates in Italy. J Gastrointestin Liver Dis. 2012 Dec; 21(4):363-5.
19. Zahraa A. G. Mohammed Ali1, Yassir M. Kamal Al-Mulla Hummadi, and Akram A. Najeeb3.Triple and Quadruple Eradication Therapy for H. pylori in Iraqi Patients with Peptic Ulcer Disease a Comparative Study. BJMMR.2015: 7(3): 231-240.
20. Miftahussurur M, Shrestha PK, Subsomwong P, Sharma RP, Yamaoka Y. Emerging Helicobacter pylori levofloxacin resistance and novel genetic mutation in Nepal.BMC Microbiol. 2016; 16(1):256.
21. Abdullahi M , Annibale B, Capoccia D, Tari R, Lahner E, Osborn J, et al. The eradication of Helicobacter pylori is affected by body mass index (BMI).Europe PMC. 2008, 18(11):1450-1454.
22. Hadeel Abdul Elah Ibrahim, Hawa A. R. Al-Dhahir and Mohammad Omer Mohammad.Effect of age, gender, blood group and social state on the seroprevalence of Helicobacter pylori Infection among asymptomatic subject in Sulaimani. JSMC. 2015: 5(1):43-50.
23. Lu H, Zhang Wand Graham DY. Bismuth-containing quadruple therapy for Helicobacter pylori: Lessons from China. Eur. J. Gastroenterol. Hepatol. 2013; 25(10):1134-1140.
24. Zullo A, De Francesco V, Bellesia A, Vassallo R, D'Angelo A, Scaccianoce et al. Bismuth-based quadruple therapy following H. pylori eradication failures: a multicenter study in clinical practice.G, J Gastrointestin Liver Dis. 2017 Sep; 26(3):225-229.
25. Kim SE, Park MI, Park SJ, Moon W, Kim JH, Jung K, Second-line bismuth-containing quadruple therapy for Helicobacter pylori eradication and impact of diabetes. World J Gastroenterol. 2017 Feb 14; 23(6): 1059–1066.
26. Pan KF, Zhang L, Gerhard M, Ma JL, Liu WD, Ulm K et al. A large randomized controlled intervention trial to prevent gastric cancer by eradication of Helicobacter pylori in Linqu County, China: baseline results and factors affecting the eradication. Gut. 2016 Jan; 65(1):9-18.
27. Istvan G. Telessy and Harpal S. Buttar. Obesity related alterations in pharmacokinetics and pharmacodynamics of drugs: emerging clinical implication in obese patints – Part II. 2017, 9:31-40.
28. Cheha KM1, Dib SOA1, Alhalabi MM1. Pilot study: Comparing the efficacy of 14-day triple therapy Clarithromycin versus levofloxacin on eradication of Helicobacter pylori infection in Syrian population single-center experience. Avicenna J Med.2018 8(1): 14-17.
29. Hsu PI, Tsai FW, Kao SS, Hsu WH, Cheng JS, Peng NJ et al. Ten-Day Quadruple Therapy Comprising Proton Pump Inhibitor, Bismuth, Tetracycline, and Levofloxacin is More Effective than Standard Levofloxacin Triple Therapy in the Second-Line Treatment of Helicobacter pylori Infection: A Randomized Controlled Trial. Am J Gastroenterol. 2017; 112(9):1374-1381.
30. Peedikayil MC, AlSohaibani FI, Alkhenizan AH.Levofloxacin-Based First-Line Therapy versus Standard First-Line Therapy for Helicobacter pylori eradication: Meta analysis of Randomized Controlled Trials. Plos One. 2014; 9(1): e85620.
31. Ahn HJ, Kim DP, Chu MS, Yun HJ, Kim SH, Lee SW, et al. Efficacy and Safety of the Triple Therapy Containing Ilaprazole, Levofloxacin, and Amoxicillin as First-Line Treatment in Helicobacter pylori infections.Gastroenterol Res Pract. 2017(3):1-6.
32. O'Connor JP, Taneike I, O'Morain C.Improving compliance with Helicobacter pylori eradication therapy: when and how?. Ther. Adv. Gastroenterol 2009; 2(5): 273- 279.
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