Third-line rescue therapy with levofloxacin after two H. pylori treatment failures.
OBJECTIVE
Eradication therapy with proton pump inhibitor, clarithromycin and amoxicillin fails in a considerable number of cases. A rescue therapy still fails in more than 20% of the cases. Our aim was to evaluate the efficacy and tolerability of a third-line levofloxacin-based regimen in patients with two consecutive Helicobacter pylori eradication failures.


METHODS



METHODS
Prospective multicenter study.


METHODS
In whom a first treatment with omeprazole-clarithromycin-amoxicillin and a second with omeprazole-bismuth-tetracycline-metronidazole (or ranitidine bismuth citrate with these antibiotics) had failed.


METHODS
A third 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.


RESULTS
Eradication was confirmed with 13C-urea breath test 4-8 wk after therapy.


RESULTS
One-hundred patients were initially included, and nine were lost for follow-up. All patients but five took all the medications correctly. Per-protocol and intention-to-treat eradication rates were 66% (95% CI = 56-75%) and 60% (50-70%). Adverse effects were reported in 25% of the patients, mainly including metallic taste (8%), nausea (8%), myalgia/arthralgia (5%), and diarrhea (4%); none of them were severe.


CONCLUSIONS
Levofloxacin-based rescue therapy constitutes an encouraging empirical third-line strategy after multiple previous H. pylori eradication failures with key antibiotics such as amoxicillin, clarithromycin, metronidazole, and tetracycline.
Gisbert
Javier P
JP
Hospital de la Princesa, Madrid, Spain.
Castro-Fernández
Manuel
M
Bermejo
Fernando
F
Pérez-Aisa
Angeles
A
Ducons
Julio
J
Fernández-Bermejo
Miguel
M
Bory
Felipe
F
Cosme
Angel
A
Benito
Luis-Miguel
LM
López-Rivas
Laureano
L
Lamas
Eloisa
E
Pabón
Manuel
M
Olivares
David
D
D000658:Amoxicillin / Q000009:adverse effects / Q000627:therapeutic use; D000863:Antacids / Q000009:adverse effects / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001729:Bismuth / Q000009:adverse effects / Q000627:therapeutic use; D001944:Breath Tests; D017291:Clarithromycin / Q000009:adverse effects / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D004791:Enzyme Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D016481:Helicobacter Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology; D016480:Helicobacter pylori / Q000187:drug effects / Q000302:isolation & purification; D006801:Humans; D064704:Levofloxacin; D008297:Male; D008795:Metronidazole / Q000009:adverse effects / Q000627:therapeutic use; D008875:Middle Aged; D015242:Ofloxacin / Q000627:therapeutic use*; D009853:Omeprazole / Q000009:adverse effects / Q000627:therapeutic use; D011446:Prospective Studies; D011500:Protein Synthesis Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D013752:Tetracycline / Q000009:adverse effects / Q000627:therapeutic use; D017211:Treatment Failure
D000863:Antacids; D000900:Anti-Bacterial Agents; D004791:Enzyme Inhibitors; D011500:Protein Synthesis Inhibitors; D008795:Metronidazole; D064704:Levofloxacin; D000658:Amoxicillin; D015242:Ofloxacin; D013752:Tetracycline; D017291:Clarithromycin; D009853:Omeprazole; D001729:Bismuth