Mono, dual and triple moxi¯oxacin-based therapies for Helicobacter pylori eradication S. DI CARO*, V. OJETTI*, M. A. ZOCCO*, F. CREMONINI*, F. BARTOLOZZI  , M. CANDELLI*, A. LUPASCU*, E. C. NISTA*, G. CAMMAROTA* & A. GASBARRINI* *Internal Medicine Department, Gemelli Hospital, Rome, Italy; and  Hygiene and Public Health Department, Catholic University, Rome, Italy Accepted for publication 17 September 2001 INTRODUCTION Many drug schemes have been proposed for Helicobacter pylori eradication. A standardized therapy, involving a combination of a proton pump inhibitor with two antibiotics (clarithromycin and amoxicillin or nitroim- idazole) given for 1 week, has been reported to achieve an eradication rate in the range 85±90%. 1 However, in clinical practice, many factors can affect the results of therapy. Among these factors, resistance to antibiotics and patient compliance are the main determinants of treatment failure in H. pylori infection. 2 As a conse- quence, the use of new drugs and simpler eradication schemes may improve the ef®cacy of therapy. The use of more recent antibiotics, such as rifabutin, nitazoxamide and ¯uoroquinolones, has not been con®rmed com- pletely in the eradication of H. pylori. 3±5 Previous studies have evaluated the ef®cacy and tolerability of levo¯oxacin-based triple therapies, and have suggested that ¯uoroquinolones could provide not only a useful alternative to standard therapy, but also a chance to overcome the increasing primary resistance to currently used antibiotics. 6 Moxi¯oxacin (BAY 12-8039), a new commercially available 8-methoxy-¯uoroquinolone (AVALOX, laun- ched by Bayer in 1999 for the treatment of respirat- ory tract infections), is a broad spectrum antibacterial agent with an improved coverage of Gram-positive (in particular Streptococcus pneumoniae) and anaerobic bacteria. 7±13 The antibacterial effect of moxi¯oxacin, as for other ¯uoroquinolones, is based on the inhibition of SUMMARY Background: Moxi¯oxacin is a broad spectrum ¯uoroqu- inolone with single daily administration, currently used, above all, for respiratory tract infections. Aim: To compare the ef®cacy of different 1-week moxi¯oxacin-based Helicobacter pylori eradication regi- mens. Methods: One hundred and twenty H. pylori-positive subjects were randomized to receive moxi¯oxacin (400 mg/day), moxi¯oxacin (400 mg/day) and lansop- razole (30 mg/day) or moxi¯oxacin (400 mg/day), lan- soprazole (30 mg/day) and clarithromycin (500 mg b.d.). H. pylori status was reassessed 6 weeks after the end of therapy, and both intention-to-treat and per protocol analyses were performed. Results: One hundred and nineteen of the 120 patients completed the study. H. pylori eradication was achieved in 22.5% of patients treated with moxi¯oxacin, in 33.3% of subjects treated with moxi¯oxacin and lansoprazole and in 90% of patients treated with moxi¯oxacin, clarithromycin and lansoprazole. Conclusions: Mono and dual moxi¯oxacin-based ther- apies are not acceptable for H. pylori eradication; conversely, moxi¯oxacin-based triple therapy may be considered as a new, effective, ®rst-line therapy option. Correspondence to: Dr A. Gasbarrini, Associate Professor of Internal Medicine, Catholic University, Gemelli Hospital, Largo Gemelli 8, 00168 Rome, Italy. E-mail: angiologia@rm.unicatt.it Aliment Pharmacol Ther 2002; 16: 527±532. Ó 2002 Blackwell Science Ltd 527