Published online Apr 21, 2020. doi: 10.3748/wjg.v26.i15.1733
Peer-review started: December 30, 2019
First decision: February 29, 2020
Revised: March 5, 2020
Accepted: April 4, 2020
Article in press: April 4, 2020
Published online: April 21, 2020
Third generation of quinolones, such as levofloxacin and moxifloxacin, -containing regimens are often used in second-line or rescue treatment of Helicobacter pylori infection. However, the increasing antibiotic resistance to quinolones affects the efficacies of quinolones-containing therapies in recent years. Therefore, there is a need to enhance the effectiveness of quinolones-containing therapies. Sitafloxacin, a fourth-generation quinolone, and vonoprazan, a novel potassium-competitive acid blocker, are now available as more effective treatment options. The aim of this paper is to summarize the current evidence of quinolone-containing therapies in rescue treatments, and to discuss the importance of drug sensitivity tests or analysis of gyrA mutation before treatments.
Core tip: The efficacies of 7-d levofloxacin or moxifloxacin, -containing regimens are becoming less effective in recent years due to the increasing antibiotic resistance, which necessitates 10-d or 14-d regimens or bismuth containing regimen are needed to achieve sufficient eradication rates. gyrA mutation is the most sensitive marker for predicting successful eradication in using quinolone-containing therapies. Thus, analysis of gyrA mutation before treatments is recommended. Seven-day sitafloxacin-amoxicillin-vonoprazan triple therapy is the best choice for third-line treatment at present.