title: A 10-day levofloxacin-based therapy in patients with resistant Helicobacter pylori infection: a controlled trial.
abstract: OBJECTIVE
  Antibiotic resistance is a major issue in anti- Helicobacter pylori treatment. This study was aimed at assessing the efficacy of 2 therapies in patients with resistant H pylori infection.
  
  
  METHODS
  Patients who had failed 1 or more eradication regimens underwent upper gastrointestinal endoscopy and 2 antral and 2 corpus biopsy specimens were taken for histology and culture. Metronidazole, clarithromycin, and amoxicillin resistance were determined by E-test. Patients were randomly assigned to 2 therapies: 1 group received pantoprazole 40 mg, amoxicillin 1 g, levofloxacin 250 mg, all twice daily for 10 days, and the other group was treated with omeprazole 20 mg twice daily for the first week and omeprazole 20 mg twice daily, tetracycline 250 mg 4 times daily, metronidazole 500 mg twice daily, and bismuth subcitrate 240 mg twice daily for the second week. Therapeutic success was evaluated by 13C urea breath test after 4 weeks of treatment.
  
  
  RESULTS
  We enrolled 44 patients in the levofloxacin-based regimen and 46 patients in the quadruple therapy. The former was successful in 31 of 44 (70%; 95% confidence interval: 53-87) and the latter in 17 of 46 (37%; 95% confidence interval: 23-47) patients, using intention-to-treat (ITT) analysis (P < .001). The rates of H pylori resistance to metronidazole, clarithromycin, and amoxicillin were 46%, 12%, and 0%, respectively. Resistance to both metronidazole and clarithromycin was found in 10% of cases.
  
  
  CONCLUSIONS
  Triple therapy containing levofloxacin was better than quadruple therapy. The 70% success rate observed indicates that 10 days of pantoprazole, amoxicillin, and levofloxacin should be considered in patients who had failed 1 or more eradication regimens.
authors.affiliation: Dipartimento di Medicina Interna e Specialità Mediche, Università di Genova, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Bilardi
authors.forename: Pietro
authors.initials: P
authors.lastname: Dulbecco
authors.forename: Patrizia
authors.initials: P
authors.lastname: Zentilin
authors.forename: Simona
authors.initials: S
authors.lastname: Reglioni
authors.forename: Elena
authors.initials: E
authors.lastname: Iiritano
authors.forename: Andrea
authors.initials: A
authors.lastname: Parodi
authors.forename: Laura
authors.initials: L
authors.lastname: Accornero
authors.forename: Edoardo
authors.initials: E
authors.lastname: Savarino
authors.forename: Carlo
authors.initials: C
authors.lastname: Mansi
authors.forename: Mario
authors.initials: M
authors.lastname: Mamone
authors.forename: Sergio
authors.initials: S
authors.lastname: Vigneri
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Savarino
mesh_terms: D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000368:Aged; D000658:Amoxicillin / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000897:Anti-Ulcer Agents / Q000627:therapeutic use*; D001562:Benzimidazoles / Q000627:therapeutic use; D017291:Clarithromycin / Q000627:therapeutic use; D004352:Drug Resistance, Microbial; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D064704:Levofloxacin; D008297:Male; D008795:Metronidazole / Q000627:therapeutic use; D008875:Middle Aged; D015242:Ofloxacin / Q000627:therapeutic use*; D009853:Omeprazole / Q000031:analogs & derivatives* / Q000627:therapeutic use; D009942:Organometallic Compounds / Q000627:therapeutic use; D000077402:Pantoprazole; D011446:Prospective Studies; D013454:Sulfoxides / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000900:Anti-Bacterial Agents; D000897:Anti-Ulcer Agents; D001562:Benzimidazoles; D009942:Organometallic Compounds; D013454:Sulfoxides; D008795:Metronidazole; D064704:Levofloxacin; D000658:Amoxicillin; D015242:Ofloxacin; D000077402:Pantoprazole; D017291:Clarithromycin; C002791:bismuth tripotassium dicitrate; D009853:Omeprazole