Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 7, 2018; 24(29): 3302-3312
Published online Aug 7, 2018. doi: 10.3748/wjg.v24.i29.3302
Fourth-generation quinolones in the treatment of Helicobacter pylori infection: A meta-analysis
Ying An, Ya Wang, Shuang Wu, You-Hua Wang, Xing Qian, Zhen Li, Ying-Jun Fu, Yong Xie
Ying An, Ya Wang, Shuang Wu, You-Hua Wang, Xing Qian, Yong Xie, Department of Gastroenterology, the First Affiliated Hospital of Nanchang University, Key Laboratory of Digestive Diseases of Jiangxi, Nanchang 330000, Jiangxi province, China
Ying An, Ya Wang, Ying-Jun Fu, School of Pharmacy, Nanchang University, Nanchang 330000, Jiangxi province, China
Zhen Li, Medical College, Nanchang University, Nanchang 330000, Jiangxi province, China
Author contributions: Fu YJ and Xie Y designed the research; An Y, Wang Y, and Wu S performed the research; Wang YH, Qian X, and Li Z contributed to analytic tools; An Y and Wang Y analyzed data; An Y and Wang Y wrote the paper.
Supported by the Graduate Innovation Project of Nanchang University, No. CX2017213 and No. CX2017251; the National Natural Science Foundation of China, No. 81460115; and the Science and Technology Projects of Jiangxi Province, No. 2014BBG70019.
Conflict-of-interest statement: The authors deny any conflict of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Yong Xie, MD, PhD, Professor, Department of Gastroenterology, the First Affiliated Hospital of Nanchang University, Key Laboratory of Digestive Diseases of Jiangxi, Nanchang 330000, Jiangxi Province, China.
Telephone: +86-791-88692507
Received: April 4, 2018
Peer-review started: April 4, 2018
First decision: April 19, 2018
Revised: May 12, 2018
Accepted: June 16, 2018
Article in press: June 16, 2018
Published online: August 7, 2018
Research background

The resistance of Helicobacter pylori (H. pylori) to antibiotics is increasing and often leads to the failure of eradication treatment. Recent studies have reported that therapies containing fourth-generation quinolones remain effective against antibiotic-resistant H. pylori. However, the efficacy and safety of these therapies require further study. This is the first meta-analysis comparing the curative effect of fourth-generation quinolones with that of other therapies in regard to eradicating H. pylori.

Research motivation

In the Maastricht IV and Maastricht V Consensus Reports, levofloxacin-based therapy is recommended when the first treatment fails. Therapies containing fourth-generation quinolones are not mentioned. Our meta-analysis focused on eradication rates, side effects and compliance of therapies containing fourth-generation quinolones when compared with therapies using non-fourth-generation quinolones.

Research objectives

This meta-analysis aimed to clarify the effect of fourth-generation quinolones on the eradication of H. pylori infection and provide some evidence for clinical practice.

Research methods

The meta-analysis was conducted according to the PRISMA criteria. We searched the PubMed, EMBASE, and Cochrane Library databases. The outcome was to calculate the pooled eradication rate and therapy-related side effects among the trials, comparing the control and experimental groups. We calculated the odds ratio of each trial for the primary measure. The odds ratios were presented with 95% confidence intervals, and a P-value < 0.05 was considered significant. This methodology was also performed for subgroup analysis.

Research results

Available data from 10 studies showed that treatment with a fourth-generation quinolone could achieve a higher H. pylori eradication rate and decrease the side effects, but the eradication rate is less than acceptable. Fourth-generation quinolones can significantly improve the eradication rate in Europe but not in Asia.

Research conclusions

Quinolone resistance increases with age and duration of use. It is essential for practitioners to use quinolone antibiotics in the clinic reasonably. This study comprehensively analyzed the role of fourth-generation quinolone in the treatment of H. pylori infection. Our results suggested that fourth-generation quinolones are not ideal for eradication of H. pylori. Treatment based on antibiotic susceptibility testing might be more valid and obtain a higher rate of eradication of H. pylori infection, particularly in areas where resistance to antibiotics develops rapidly.

Research perspectives

According to reports that mutations at positions 87 and 91 of gyrA are the main cause of H. pylori resistance to fourth-generation quinolones, we will continue to pay attention to the resistance rate to fourth-generation quinolones globally. We will also focus on rapid genotyping methods, such as detecting gyrA mutations in H. pylori. Further studies of sitafloxacin, gemifloxacin, and gatifloxacin are imperative to draw more solid conclusions about the use of fourth-generation quinolones for the eradication of H. pylori infection.