Oleh Admin Kalbe Medical pada April 20, 2017 07:30

Levofloxacin Based Triple Therapy pada Infeksi Helicobacter pylory Refrakter di Australia

Infeksi Helicobacter pylori merupakan infeksi yang sering terjadi di seluruh dunia dan merupakan salah satu faktor penting yang dapat mengakibatkan ulkus gaster dan kanker lambung. Berbagai hal yang dapat meningkatkan risiko terjadinya infeksi bakteri tersebut antara lain ialah pengobatan dengan obat anti-inflamasi non-steroid, anemia defisiensi besi, dan idiopathic thrombocytopenic purpura.

Menurut literatur yang berjudul: “ACG Clinical Guideline: Treatment of Helicobacter pylori Infection”, sebagai terapi lini pertama, clarithromycin triple therapy dapat diberikan pada pasien yang tidak memiliki riwayat paparan macrolide yang berada pada daerah di mana resistensi H. pylori terhadap clarithromycin masih rendah. Literatur tersebut juga mengatakan bahwa pasien-pasien dengan infeksi H. pylori ini akan lebih baik diterapi dengan bismuth quadruple therapy atau terapi konkomitan yang terdiri atas Proton Pump Inhibitor (PPI), clarithromycin, amoxicillin, dan metronidazole. Jika terapi lini pertama gagal, terapi penyelamatan harus dilakukan dengan menghindari terapi yang telah dicoba sebelumnya. Jika terjadi kegagalan dengan terapi awal yang mengandung clarithromycin, maka bismuth quadruple therapy atau terapi penyelamatan dengan levofloxacin dapat dilakukan.

Suatu studi menilai efikasi terapi penyelamatan dengan levofloxacin pada pasien-pasien dengan infeksi H. pylori yang telah gagal pada pemberian terapi lini pertama. Studi ini menyelidiki efikasi terapi penyelamatan dengan levofloxacin (kombinasi esomeprazole 40 mg, amoxicillin 1 g, dan levofloxacin 500 mg, masing-masing dua kali sehari selama sepuluh hari) pada pasien-pasien dengan infeksi H. pylori yang telah gagal diterapi dengan terapi lini pertama berupa PPI, amoxicillin, dan clarithromycin selama tujuh hari.

Dari 150 pasien yang disertakan dalam studi ini, didapatkan hasil berupa eradikasi H. pylori yang dicapai pada 90% pasien (ITT) dan 91% (PP), sehingga studi ini menganjurkan untuk menggunakan levofloxacin-based triple therapy sebagai terapi penyelamatan pada pasien-pasien yang telah gagal diterapi dengan terapi lini pertama untuk eradikasi H.pylori karena efikasi dan keamanan yang telah terbukti. Namun, untuk aplikasi terapi ini di Indonesia tentunya perlu dilakukan peninjauan lebih lanjut. (AHA)

Image : Ilustrasi
Referensi:
1.Chey WD, Leontiadis GI, Howden CW, Moss SF. ACG clinical guideline: Treatment of Helicobacter pilory infection. Am J Gastroenterol. 2017;112(2):212-39.  doi: 10.1038/ajg.2016.563.
2.Katelaris PH, Katelaris AL. A prospective evaluation of levofloxacin based triple therapy for refractory Helicobacter pylori infection in Australia. Intern Med J. 2017 Mar 27.  doi: 10.1111/imj.13432.

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