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Second-line rescue therapy with levofloxacin after H. pylori treatment failure: a Spanish multicenter study of 300 patients.
JP. Gisbert, F. Bermejo, M. Castro-Fernández, A. Pérez-Aisa, M. Fernández-Bermejo, A. Tomas, J. Barrio, F. Bory, P. Almela, P. Sánchez-Pobre, A. Cosme, V. Ortiz, P. Niño, S. Khorrami, LM. Benito, JA. Carneros, E. Lamas, I. Modolell, A. Franco, J. Ortuño, L. Rodrigo, F. García-Durán, E. O'Callaghan, J. Ponce, MP. Valer, X. Calvet, .
Am. J. Gastroenterol. 2008 Jan;103(1):71-6.
PubMed: 17764498
Abstract
Quadruple therapy is generally recommended as second-line therapy after Helicobacter pylori (H. pylori) eradication failure. However, this regimen requires the administration of four drugs with a complex scheme, is associated with a relatively high incidence of adverse effects, and bismuth salts are not available worldwide anymore. Our aim was to evaluate the efficacy and tolerability of a triple second-line levofloxacin-based regimen in patients with H. pylori eradication failure. Prospective multicenter study. in whom a first treatment with proton pump inhibitor-clarithromycin-amoxicillin had failed. A second eradication regimen with levofloxacin (500 mg b.i.d.), amoxicillin (1 g b.i.d.), and omeprazole (20 mg b.i.d.) was prescribed for 10 days. Eradication was confirmed with (13)C-urea breath test 4-8 wk after therapy. Compliance with therapy was determined from the interview and the recovery of empty envelopes of medications. Incidence of adverse effects was evaluated by means of a specific questionnaire. Three hundred consecutive patients were included. Mean age was 48 yr, 47% were male, 38% had peptic ulcer, and 62% functional dyspepsia. Almost all (97%) patients took all the medications correctly. Per-protocol and intention-to-treat eradication rates were 81% (95% CI 77-86%) and 77% (73-82%). Adverse effects were reported in 22% of the patients, mainly including nausea (8%), metallic taste (5%), abdominal pain (3%), and myalgias (3%); none of them were severe. Ten-day levofloxacin-based rescue therapy constitutes an encouraging second-line strategy, representing an alternative to quadruple therapy in patients with previous proton pump inhibitor-clarithromycin-amoxicillin failure, being simple and safe.
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Structure | Number of references |
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Urea | 1130 |