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World J Pharmacol. Dec 9, 2015; 4(4): 274-280
Published online Dec 9, 2015. doi: 10.5497/wjp.v4.i4.274
Quinolone-based first, second and third-line therapies for Helicobacter pylori
Enzo Ierardi, Giuseppe Losurdo, Floriana Giorgio, Andrea Iannone, Mariabeatrice Principi, Alfredo Di Leo
Enzo Ierardi, Giuseppe Losurdo, Floriana Giorgio, Andrea Iannone, Mariabeatrice Principi, Alfredo Di Leo, Gastroenterology Section, Department of Emergency and Organ Transplantation, University of Bari, 70124 Bari, Italy
Author contributions: Ierardi E and Di Leo A planned the article; Losurdo G, Giorgio F and Iannone A found and analyzed the data; Ierardi E, Losurdo G and Principi M wrote the manuscript; all authors read and approved the final version.
Conflict-of-interest statement: There is no conflict of interest associated with any of the senior author or other coauthors contributed their efforts in this manuscript.
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: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Enzo Ierardi, Professor, Gastroenterology Section, Department of Emergency and Organ Transplantation, University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy. e.ierardi@virgilio.it
Telephone: +39-80-5594034 Fax: +39-80-5593088
Received: July 14, 2015
Peer-review started: July 15, 2015
First decision: September 28, 2015
Revised: October 26, 2015
Accepted: November 13, 2015
Article in press: November 17, 2015
Published online: December 9, 2015
Processing time: 146 Days and 22.8 Hours
Abstract

Helicobacter pylori (H. pylori) is a very common bacterium that infects about 50% of the world population in urban areas and over 90% of people living in rural and developing countries. Fluoroquinolones, a class of antimicrobials, have been extensively used in eradication regimens for H. pylori. Levofloxacin is the most commonly used, and in second-line regimens, is one of the most effective options. However, an increasing resistance rate of H. pylori to fluoroquinolones is being observed, that will likely affect their effectiveness in the near future. Other novel fluoroquinolone molecules, such as moxifloxacin, sitafloxacin, gatifloxacin and gemifloxacin, have been proposed and showed encouraging results in vitro, although data on their clinical use are still limited. Further studies in large sample trials are needed to confirm their safety and efficacy profile in clinical practice.

Keywords: Helicobacter pylori; Eradication regimens; Fluoroquinolones; Antibiotic resistance; Levofloxacin; Rescue treatments

Core tip: In the present minireview, we analyzed current evidence about the use of fluoroquinolones in first, second and third-line eradication regimens for Helicobacter pylori (H. pylori). The increasing resistances to levofloxacin are a worrying issue, that confirm the need to use this drug with proper care. We analyzed the current use of fluoroquinolones in first-line and rescue regimens, underlining possible pitfalls and mistakes that could be avoided in clinical practice. Novel molecules have been investigated, that could offer an interesting tool to combat H. pylori.