Published online Aug 7, 2018. doi: 10.3748/wjg.v24.i29.3302
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
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.
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.
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.
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.
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.
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.
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.