Multi-center randomized controlled study to establish the standard third-line regimen for Helicobacter pylori eradication in Japan

• DOI: 10.1007/s00535-012-0731-8
• Publication Date: 2013-01-09T20:27:26Z
• Authors: Kazunari Murakami; Takahisa Furuta; Takashi Ando; Takeshi Nakajima; Yoshikatsu Inui; Tadayuki Oshima; Toshihiko Tomita; Katsuhiro Mabe; Makoto Sasaki; Takanori Suganuma; Hideyuki Nomura; Kiichi Satoh; Shinichiro Hori; Syuuji Inoue; Takeshi Tomokane; Mineo Kudo; Tomoki Inaba; Susumu Take; Toshifumi Ohkusa; Shojiro Yamamoto; Shigeaki Mizuno; Toshiro Kamoshida; Kenji Amagai; Junichi Iwamoto; Jun Miwa; Masaaki Kodama; Tadayoshi Okimoto; Mototsugu Kato; Masahiro Asaka
• Keywords: Male; Helicobacter pylori; Drug Resistance; Amoxicillin; Levofloxacin; Middle Aged; Anti-Ulcer Agents; Helicobacter Infections; 3. Good health; 03 medical and health sciences; Treatment Outcome; 0302 clinical medicine; Japan; Humans; Drug Therapy, Combination; Female; Lansoprazole; Aged; Fluoroquinolones

The present study sought to establish a standard third-line eradication regimen for Helicobacter pylori in Japan.Subjects were 204 patients with H. pylori infection in whom the standard Japanese first- and second-line eradication therapies had proven unsuccessful. Patients were randomly assigned to one of the following third-line eradication therapy groups: (1) LA group: lansoprazole (LPZ) 30 mg 4 times a day (qid) + amoxicillin (AMPC) 500 mg qid for two weeks; (2) LAL group: LPZ 30 mg twice a day (bid) + AMPC 750 mg bid + levofloxacin (LVFX) 300 mg bid for one week; (3) LAS group: LPZ 30 mg bid + AMPC 750 mg bid + sitafloxacin (STFX) 100 mg bid for one week. Patients for whom these therapies failed underwent a crossover fourth-line eradication regimen. Drug sensitivity was also tested for AMPC, clarithromycin (CAM), MNZ, LVFX, and STFX.Drug resistance rates prior to third-line eradication therapy were 86.4 % for CAM, 71.3 % for MNZ, 57.0 % for LVFX, 8.2 % for AMPC, and 7.7 % for STFX. Intention-to-treat analysis of third-line eradication therapy eradication rates showed a significantly higher rate in the LAS group (70.0 %) compared with the LA group (54.3 %; p < 0.05) and the LAL group (43.1 %; p < 0.001). The significantly lower rate in the LAL group than the LAS group was caused by bacterial resistance to LVFX.The findings suggest that triple therapy with PPI, AMPC, and STFX for one week would be an effective standard third-line eradication regimen for H. pylori in Japan.