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Abstract
Background/Aims
Moxifloxacin-based sequential therapy showed an excellent eradication rate as the first line treatment of Helicobacter pylori (H. pylori) infection. However, to the best of our knowledge, there were only a few studies on the treatment of those with failed moxifloxacin-based sequential therapy. Hence, this study was to investigate the efficacy of bismuth-containing quadruple therapy in those with failed moxifloxacin-based sequential or reverse sequential therapy for H. pylori eradication.
Methods
Between January 2013 and March 2016, we retrospectively analyzed patients who failed to eradicate H. pylori using moxi-floxacin-based sequential (rabeprazole 20 mg bid and amoxicillin 1 g bid for 5–7 days, followed by rabeprazole 20 mg bid, metronidazole 500 mg bid, and moxifloxacin 400 mg qd for 5–7 days) and 10 days moxifloxacin-based reverse sequential therapy as the first line treatment. Then we investigated the eradication rates of bismuth-containing quadruple therapy as the second line treatment. All subjects had no history of H. pylori eradication before. Eradication rates were described as intention-to-treat (ITT) and per-protocol (PP) analyses. H. pylori status was evaluated by 13 C-urea breath test 6 weeks after the end of the treatment. Moreover, we examined any side effects that caused discontinuation of therapy.
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References
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 | Fig. 1.Comparison of eradication rates according to the first line therapy. Eradication rates are presented by intention-to-treat (ITT) and per-protocol (PP) analyses. There was no statistically significant difference according to the first line therapy by both ITT (p-value= 0.257) and PP analyses (p-value=0.278). A, 10 days sequential; B, 14 days sequential; C, reverse sequential. |
Table 1.
Baseline Characteristics of Enrolled Patients according to the First Line Therapy
| Variable | 10 days sequential (n=10) | 14 days sequential (n=5) | Reverse sequential (n=8) | p-value |
|---|---|---|---|---|
| Age | 63.50±1.59 | 59.4±3.36 | 61.0±2.95 | 0.125 |
| Sex | ||||
| Male | 6 (60) | 3 (60) | 2 (25) | 0.294 |
| Female | 4 (40) | 2 (40) | 6 (75) | 0.294 |
| Current smoker | 0 | 0 | 0 | |
| Alcohol consumption | 0 | 0 | 0 | |
| EGD findings | 0.052 | |||
| Gastritis | 9 (90) | 5 (100) | 7 (87.5) | |
| Duodenal ulcer | 1 (10) | 0 | 1 (12.5) | |
| Underlying diseases | ||||
| HTN | 4 (50) | 1 (12.5) | 3 (37.5) | 0.743 |
| DM | 1 (100) | 0 | 0 | >0.999 |
| Hyperlipidemia | 1 (50) | 0 | 1 (50) | >0.999 |
| Thyroid disease | 0 | 1 (50) | 1 (50) | 0.308 |
| Time interval (days) a | 67.42±43.56 | 63.86±36.23 | 77.40±64.07 | 0.125 |
| Second line treatment results | ||||
| Eradicated | 4 (40) | 4 (80) | 6 (75) | 0.257 |
| Not eradicated | 3 (30) | 0 | 2 (25) | 0.563 |
| Follow up loss | 3 (30) | 1 (20) | 0 | 0.298 |
Table 2.
Comparison of Eradicated and not Eradicated Groups
| Variable | Total (n=19) | Eradicated (n=14) | Not eradicated (n=5) | p-value |
|---|---|---|---|---|
| Age | 62.74±6.38 | 62.50±7.08 | 63.40±4.39 | 0.964 |
| Sex | ||||
| Male | 9 (47.4) | 7 (50) | 2 (40) | >0.99 |
| Female | 10 (52.6) | 7 (50) | 3 (60) | >0.99 |
| Current smoker | 0 | 0 | 0 | |
| Alcohol consumption | 0 | 0 | 0 | |
| EGD findings | 0.052 | |||
| Gastritis | 18 (94.7) | 18 (100) | 0 | |
| Duodenal ulcer | 1 (5.3) | 0 | 1 (100) | |
| Underlying diseases | ||||
| HTN | 7 (100) | 6 (85.7) | 1 (14.3) | 0.602 |
| Hyperlipidemia | 2 (100) | 1 (50) | 1 (50) | >0.999 |
| Thyroid disease | 1 (100) | 1 (100) | 0 | >0.999 |
| Time intervals (days)a | 67.42±43.56 | 63.86±36.23 | 77.40±64.07 | 0.964 |
| First line therapy regimen | 0.278 | |||
| 10 days sequential | 7 (36.8) | 4 (57.14) | 3 (42.86) | |
| 14 days sequential | 4 (21.1) | 4 (100) | 0 | |
| Reverse sequential | 8 (42.1) | 6 (75) | 2 (25) | |
| Adverse events b | ||||
| Nausea | 4 (21.1) | 3 (75) | 1 (25) | >0.999 |
| Epigastric soreness | 2 (10.5) | 2 (100) | 0 | 0.687 |
| Dyspepsia | 1 (5.3) | 1 (100) | 0 | 0.823 |
| Abdominal discomfort | 1 (5.3) | 0 | 1 (100) | 0.559 |
| Fatigue | 1 (5.3) | 0 | 1 (100) | 0.559 |
| Diarrhea | 1 (5.3) | 1 (100) | 0 | 0.823 |
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