Second-line rescue therapy with levofloxacin after H. pylori treatment failure: a Spanish multicenter study of 300 patients

Javier P Gisbert, Fernando Bermejo, Manuel Castro-Fernández, Angeles Pérez-Aisa, Miguel Fernández-Bermejo, Albert Tomas, José Barrio, Felipe Bory, Pedro Almela, Pilar Sánchez-Pobre, Angel Cosme, Vicente Ortiz, Pilar Niño, Sam Khorrami, Luis-Miguel Benito, Jose-Antonio Carneros, Eloisa Lamas, Inés Modolell, Alejandro Franco, Juan Ortuño, Luis Rodrigo, Fernando García-Durán, Elena O'Callaghan, Julio Ponce, María-Paz Valer, Xavier Calvet
American Journal of Gastroenterology 2008, 103 (1): 71-6

AIM: 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.

METHODS: <AbstractText Label="DESIGN" NlmCategory="METHODS">Prospective multicenter study.

PATIENTS: in whom a first treatment with proton pump inhibitor-clarithromycin-amoxicillin had failed.

INTERVENTION: 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.

OUTCOME: 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.

RESULTS: 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.

CONCLUSION: 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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