Journal List > Korean J Gastroenterol > v.70(2) > 1007731

Kwon, Lee, Kang, Kim, Park, Shin, Yoon, and Choi: The Efficacy of Moxifloxacin-containing Triple Therapy after Hybrid Therapy Failure in Helicobacter pylori Eradication

Abstract

Background/Aims

Hybrid therapy was successful in eradicating Helicobacter pylori (H. pylori) according to previous reports. However, to the best of our knowledge, there have only been a few studies evaluating the optimal choice after hybrid failure. Hence, we aimed to evaluate the efficacy of moxifloxacin-containing triple therapy after hybrid therapy failure in H. pylori eradication.

Methods

Between January 2013 and March 2016, we retrospectively reviewed patients who underwent failed hybrid therapy, as first line treatment, in eradicating H. pylori (rabeprazole and amoxicillin b.i.d for 14 days, in addition to clarithromycin and metronidazole b.i.d for final 7 days). Then, we investigated the eradication rates of moxifloxacin-containing triple therapy (rabeprazole, amoxicillin b.i.d and moxifloxacin qd) as the second line of treatment. Intention-to-treat (ITT) and per-protocol (PP) analyses were used to determine the eradication rate. We evaluated the status of H. pylori by using 13 C-urea breath test 6 weeks after the final treatment. Moreover, compliance and adverse effects of each patient were analyzed.

Results

Among those who failed the initial hybrid therapy, 11 patients received moxifloxacin-containing triple therapy. The overall eradication rates, as determined by ITT and PP, were 72.7% (n=8/11) and 80% (n=8/10), respectively. The compliance rate was 100%, and there were no serious adverse effects.

Conclusions

Moxifloxacin-containing triple therapy can be used as a second line therapy in case of hybrid therapy failure. A large scale study is necessary to confirm the findings of this study and establish clinical evidence.

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Fig. 1.
Eradication rates of the overall and 14-days moxifloxacin-containing triple therapy as the second line therapy after hybrid therapy failure. It is presented by intention-to-treat (ITT) and per-protocol (PP) analyses.
kjg-70-72f1.tif
Table 1.
Baseline Characteristics of Enrolled Patients
Patient number Sex Age Alcohol Current smoker Underlying diseases EGD findings Time intervals (days)a Treatment duration (days)b Treatment results b Compliance b Adverse eventsb
1 F 66 No No Osteoporosis Gastritis 47 14 Eradicated 100% None
2 F 71 No No HTN Gastritis 84 7 Eradicated 100% None
3 M 63 Yes No DM/HTN Gastritis 129 14 Eradicated 100% None
4 M 46 Yes Yes None Gastric ulcer 97 14 Eradicated 100% None
5 M 62 Yes No DM/HTN Gastritis 46 14 Eradicated 100% None
6 F 75 No No None Gastritis 53 14 Eradicated 100% None
7 M 64 Yes No DM/ALD Gastritis 102 14 Follow up loss    
8 F 60 No No None Gastritis 61 14 Not eradicated 100% None
9 M 67 No No HTN/BPH Not done 45 14 Not eradicated 100% None
10 F 66 No No None Duodenal ulcer 41 14 Eradicated 100% Loose stool
11 F 57 No No None Gastritis 399 14 Eradicated 100% None

EGD, esophagogastroduodenoscopy; F, female; M, male; HTN, hypertension; DM, diabetes mellitus; ALD, alcoholic liver disease; BPH, benign prostate hyperplasia.

a Time intervals between first and second treatment; b Moxifloxacin-containing triple therapy.

Table 2.
Comparison of Eradicated and Not Eradicated Groups
Variable Total (n=11) Eradicated (n=8) Not eradicated (n=2) p-value
Age 63.36±2.28 63.25±3.13 63.50±3.5 0.971
Sex       0.491
    Male 5 (45.5) 3 (37.5) 1 (50)  
    Female 6 (54.5) 5 (62.5) 1 (50)  
Current smoker 1 (9.1) 1 (12.5) 0 0.814
Alcohol consumption 4 (36.4) 3 (27.5) 0 0.235
EGD findings       0.481
    Gastritis 8 (72.7) 6 (75) 1 (50)  
    Gastric ulcer 1 (9.1) 1 (12.5) 0  
    Duodenal ulcer 1 (9.1) 1 (12.5) 0  
    Nonea 1 (9.1) 0 1 (50)  
Underlying diseases       0.179
    DM 3 (27.3) 3 (37.5) 0 0.461
    HTN 4 (36.4) 3 (37.5) 1 (50) 0.692
    Osteoporosis 1 (9.1) 1 (12.5) 0 0.814
    BPH 1 (9.1) 0 1 (50) 0.084
    ALD 1 (9.1) 1 (12.5) 0 0.814
Time intervals (days)b 100±31.11 112±42.42 53±8 0.525
Treatment duration (days)c        
    7 1 (9.1) 1 (100)    
    14 9 (81.8) 7 (77.8) 2 (22.2) 0.814
Adverse eventsc
    Loose stool 1 (9.1) 1 (100)    

Values are presented as mean±standard deviation or n (%).

EGD, esophagogastroduodenoscopy; DM, diabetes mellitus; HTN, hypertension; BPH, benign prostate hyperplasia; ALD, alcoholic liver disease.

a Performed only 13 C-UBT, because examed esophagogastroduodenoscopy in other hospital

b Time intervals between first and second treatment; c Moxifloxacin-containing triple therapy.

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