Second-line rescue triple therapy with levofloxacin after failure of non-bismuth quadruple "sequential" or "concomitant" treatment to eradicate H. pylori infection. (June 2013)

• Record Type: Journal Article
• Authors: Gisbert, Javier P.; Molina-Infante, Javier; Marin, Alicia C.; Vinagre, Gemma; Barrio, Jesus; McNicholl, Adrian Gerald
• Is Part Of: Scandinavian journal of gastroenterology. Volume 48:Number 6(2013)
• Page Start: 652
• Page End: 656
• Publication Date: 2013-06
• Subjects: Gastroenterology -- Periodicals; Digestive organs -- Diseases -- Periodicals; 616.33
• DOI: 10.3109/00365521.2013.786132
• Languages: English
• ISSNs: 0036-5521

Abstract

<abstract> <title>Abstract</title> <p> <bold> <italic>Background.</italic> </bold> Non-bismuth quadruple "sequential" and "concomitant" regimens, including a proton pump inhibitor (PPI), amoxicillin, clarithromycin and a nitroimidazole, are increasingly used as first-line treatments for <italic>Helicobacter pylori</italic> infection. Eradication with rescue regimens may be challenging after failure of key antibiotics such as clarithromycin and nitroimidazoles. <bold><italic>Aim.</italic></bold> To evaluate the efficacy and tolerability of a second-line levofloxacin-containing triple regimen (PPI–amoxicillin–levofloxacin) in the eradication of <italic>H. pylori</italic> after non-bismuth quadruple-containing treatment failure. <bold><italic>Methods.</italic></bold><italic>Design:</italic> prospective multicenter study. <italic>Patients:</italic> in whom a non-bismuth quadruple regimen, administered either sequentially (PPI + amoxicillin for 5 days followed by PPI + clarithromycin + metronidazole for 5 more days) or concomitantly (PPI + amoxicillin + clarithromycin + metronidazole for 10 days) had previously failed. <italic>Intervention:</italic> levofloxacin (500 mg b.i.d.), amoxicillin (1 g b.i.d.) and PPI (standard dose b.i.d.) for 10 days. <italic>Outcome:</italic> eradication was confirmed with <sup>13</sup>C-urea breath test 4–8 weeks after therapy. <italic>Compliance and toleranc</italic>e: compliance was determined through questioning and recovery of empty medication envelopes. Incidence of adverse effects was evaluated by means of a questionnaire. <bold><italic>Results.</italic></bold> 100 consecutive patients were included (mean age 50 years, 62% females, 12% peptic ulcer and 88% dyspepsia): 37 after "sequential", and 63 after "concomitant" treatment failure. All patients took all medications correctly. Overall, per-protocol and intention-to-treat <italic>H. pylori</italic> eradication rates were 75.5% (95% CI 66–85%) and 74% (65–83%). Respective intention-to-treat cure rates for "sequential" and "concomitant" failure regimens were 74.4% and 71.4%, respectively. Adverse effects were reported in six (6%) patients; all of them were mild. <bold><italic>Conclusion.</italic></bold> Ten-day levofloxacin-containing triple therapy constitutes an encouraging second-line strategy in patients with previous non-bismuth quadruple "sequential" or "concomitant" treatment failure.</p> </abstract>