Published online Dec 14, 2015. doi: 10.3748/wjg.v21.i46.13124
Peer-review started: May 11, 2015
First decision: June 19, 2015
Revised: July 6, 2015
Accepted: September 2, 2015
Article in press: September 2, 2015
Published online: December 14, 2015
AIM: To assess the efficacy of moxifloxacin-containing triple therapy after non-bismuth quadruple therapy failure for Helicobacter pylori (H. pylori) eradication.
METHODS: Between January 2010 and December 2012, we screened individuals who were prescribed non-bismuth quadruple therapy for H. pylori eradication. Among them, a total of 98 patients who failed non-bismuth quadruple therapy received 1-wk or 2-wk moxifloxacin-containing triple therapy (400 mg moxifloxacin once daily, and 20 mg of rabeprazole and 1 g of amoxicillin twice daily). H. pylori status was evaluated using the 13C-urea breath test 4 wk later, after treatment completion. The eradication rates were determined by intention-to-treat and per-protocol analyses.
RESULTS: In total, 60 and 38 patients received 1-wk and 2-wk moxifloxacin-containing triple therapy, respectively. The intention-to-treat and per-protocol eradication rates were 56.7% (95%CI: 45.0-70.0) and 59.6% (95%CI: 46.6-71.7) in the 1-wk group and 76.3% (95%CI: 63.2-89.5) and 80.6% (95%CI: 66.7-91.9) in the 2-wk group (P = 0.048 and 0.036, respectively). All groups had good compliance (95% vs 94.9%). Neither group showed serious adverse events, and the proportions of patients experiencing mild side effects were not significantly different (21.1% vs 13.9%). Clinical factors such as age, sex, alcohol and smoking habits, comorbidities, and presence of gastric or duodenal ulcer did not influence the eradication therapy efficacy. The efficacy of second-line eradication therapy did not differ significantly according to the first-line regimen.
CONCLUSION: Two-week moxifloxacin-containing triple therapy showed better efficacy than a 1-wk regimen after non-bismuth quadruple therapy failure.
Core tip: We aimed to compare 1-wk and 2-wk moxifloxacin-containing triple therapies after non-bismuth quadruple therapy failure for Helicobacter pylori (H. pylori) infection, especially in patients from a region known to be associated with a high resistance to antibiotics. The eradication rate of the 2-wk group was significantly higher than that of the 1-wk group (76.3% vs 56.7%, P < 0.05), and the incidence of side effects was similar. Thus, a 2-wk regimen may be a reasonable choice as second-line therapy for the eradication of H. pylori infection after non-bismuth quadruple therapy failure.