Moxifloxacin-Containing Triple Therapy as Second-Line Treatment for Helicobacter pylori Infection: Effect of Treatment Duration and Antibiotic Resistance on the Eradication Rate

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.Di Caro S, 2009, DIGEST LIVER DIS, V41, P480, DOI 10.1016/j.dld.2008.09.013Hung KH, 2009, HELICOBACTER, V14, P61, DOI 10.1111/j.1523-5378.2009.00655.xKanizaj TF, 2009, HELICOBACTER, V14, P29, DOI 10.1111/j.1523-5378.2009.00656.xBago J, 2009, WIEN KLIN WOCHENSCHR, V121, P47, DOI 10.1007/s00508-008-1122-2Kilic ZMY, 2008, DIGEST DIS SCI, V53, P3133, DOI 10.1007/s10620-008-0285-zKawai T, 2008, J GASTROEN HEPATOL, V23, pS171, DOI 10.1111/j.1440-1746.2008.05408.xGisbert JP, 2008, WORLD J GASTROENTERO, V14, P5385, DOI 10.3748/wjg.14.5385Kang JM, 2007, HELICOBACTER, V12, P623Uygun A, 2007, J DIG DIS, V8, P211, DOI 10.1111/j.1443-9573.2007.00308.xSezgin O, 2007, HELICOBACTER, V12, P518Chey WD, 2007, AM J GASTROENTEROL, V102, P1808, DOI 10.1111/j.1572-0241.2007.01393.xFischbach L, 2007, ALIMENT PHARM THERAP, V26, P343, DOI 10.1111/j.1365-2036.2007.03386.xMalfertheiner P, 2007, GUT, V56, P772, DOI 10.1136/gut.2006.101634Bago P, 2007, WIEN KLIN WOCHENSCHR, V119, P372, DOI 10.1007/s00508-007-0807-2Zagari RM, 2007, GUT, V56, P475, DOI 10.1136/gut.2006.102269Carothers JJ, 2007, CLIN INFECT DIS, V44, pE5Paoluzi P, 2006, HELICOBACTER, V11, P562Kadaylfci A, 2006, CLIN THER, V28, P1960, DOI 10.1016/j.clinthera.2006.11.011Kim N, 2006, J CLIN GASTROENTEROL, V40, P683Saad RJ, 2006, AM J GASTROENTEROL, V101, P488, DOI 10.1111/j.1572-0241.2006.00455.xCheon JH, 2006, HELICOBACTER, V11, P46Wong WM, 2006, ALIMENT PHARM THERAP, V23, P421, DOI 10.1111/j.1365-2036.2006.02764.xLEE JH, 2006, KOREAN J GASTROENTER, V48, P19Gisbert JP, 2006, ALIMENT PHARM THERAP, V23, P35, DOI 10.1111/j.1365-2036.2006.02737.xTHONGNGAM D, 2006, J MED ASS THAI S3, V89, pS119KANG MS, 2006, KOREAN J GASTROENTER, V47, P30Kim JM, 2005, J ANTIMICROB CHEMOTH, V56, P965, DOI 10.1093/jac/dki334Matsumoto Y, 2005, DIGEST LIVER DIS, V37, P821, DOI 10.1016/j.dld.2005.06.002Nista EC, 2005, ALIMENT PHARM THERAP, V21, P1241, DOI 10.1111/j.1365-2036.2005.02412.xKim JM, 2004, ANTIMICROB AGENTS CH, V48, P4843, DOI 10.1128/AAC.48.12.4843-4847.2004Schabereiter-Gurtner C, 2004, J CLIN MICROBIOL, V42, P4512, DOI 10.1128/JCM.42.10.4512-4518.2004Ball P, 2004, CLIN THER, V26, P940Lamouliatte H, 2003, ALIMENT PHARM THERAP, V18, P791, DOI 10.1046/j.1365-2036.2003.01759.xFORD A, 2003, CAN J GASTROENTEROL, V17, pB36Suerbaum S, 2002, NEW ENGL J MED, V347, P1175Gisbert JP, 2002, ALIMENT PHARM THERAP, V16, P1047Michopoulos S, 2000, ALIMENT PHARM THERAP, V14, P737Graham DY, 2000, ALIMENT PHARM THERAP, V14, P745Calvet X, 2000, ALIMENT PHARM THERAP, V14, P603Realdi G, 1999, HELICOBACTER, V4, P106Versalovic J, 1996, ANTIMICROB AGENTS CH, V40, P477MOORE RA, 1995, ANTIMICROB AGENTS CH, V39, P1071