title: A third-line levofloxacin-based rescue therapy for Helicobacter pylori eradication.
abstract: BACKGROUND
  Helicobacter pylori infection persists in a considerable proportion of patients after both first- and second-line current treatments. A standard therapy for re-treatment in such refractory patients is still lacking. This study aimed to evaluate the efficacy of a levofloxacin-amoxycillin combination in patients who previously failed two or more therapeutic attempts.
  
  
  METHODS
  Consecutive patients with persistent Helicobacter pylori infection were enrolled. Bacterial infection was assessed by rapid urease test and histology on gastric biopsies at endoscopy. Patients were assigned to receive a 10-day triple therapy, comprising rabeprazole 20 mg b.d., levofloxacin 250 mg b.d., and amoxycillin 1 g b.d. Four to 6 weeks after therapy, Helicobacter pylori eradication was assessed by a further endoscopy or 13C urea breath test.
  
  
  RESULTS
  Overall, 36 patients were enrolled, but two patients were lost to follow-up. Helicobacter pylori was successfully cured in 30 patients, giving an 83.3% (95% CI=71.2-95.5) and 88.2% (95% CI=77.4-99) eradication rate at intention-to-treat and per protocol analysis, respectively. Compliance was good in all but two patients, who discontinued the treatment at 8 and 6 days, respectively, on account of glossitis. No major side-effects were reported, whilst 7 (20.1%) patients complained of mild side-effects.
  
  
  CONCLUSIONS
  This study demonstrates that a 10-day levofloxacin-amoxycillin triple therapy is a safe and successful third-line therapeutic approach for Helicobacter pylori eradication.
authors.affiliation: Gastroenterology and Digestive Endoscopy, Nuovo Regina Margherita Hospital, Via Morosini 30, 00153 Rome, Italy. zullo@tiscali.it
authors.forename: A
authors.initials: A
authors.lastname: Zullo
authors.forename: C
authors.initials: C
authors.lastname: Hassan
authors.forename: V
authors.initials: V
authors.lastname: De Francesco
authors.forename: R
authors.initials: R
authors.lastname: Lorenzetti
authors.forename: M
authors.initials: M
authors.lastname: Marignani
authors.forename: S
authors.initials: S
authors.lastname: Angeletti
authors.forename: E
authors.initials: E
authors.lastname: Ierardi
authors.forename: S
authors.initials: S
authors.lastname: Morini
mesh_terms: D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000328:Adult; D000368:Aged; D000658:Amoxicillin / Q000008:administration & dosage*; D000890:Anti-Infective Agents / Q000008:administration & dosage*; D000897:Anti-Ulcer Agents / Q000008:administration & dosage*; D001562:Benzimidazoles / Q000008:administration & dosage*; D001944:Breath Tests; D004334:Drug Administration Schedule; D024881:Drug Resistance, Bacterial; D004359:Drug Therapy, Combination; D016145:Endoscopy, Digestive System; D005260:Female; D005928:Glossitis / Q000209:etiology; D016481:Helicobacter Infections / Q000188:drug therapy*; D016480:Helicobacter pylori; D006801:Humans; D064704:Levofloxacin; D008297:Male; D008875:Middle Aged; D015242:Ofloxacin / Q000008:administration & dosage* / Q000009:adverse effects; D009853:Omeprazole / Q000031:analogs & derivatives; D010406:Penicillins / Q000008:administration & dosage*; D011446:Prospective Studies; D064750:Rabeprazole; D016896:Treatment Outcome; D014508:Urea
chemical_list: D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000890:Anti-Infective Agents; D000897:Anti-Ulcer Agents; D001562:Benzimidazoles; D010406:Penicillins; D064750:Rabeprazole; D064704:Levofloxacin; D000658:Amoxicillin; D014508:Urea; D015242:Ofloxacin; D009853:Omeprazole