Third-line rescue therapy with levofloxacin is more effective than rifabutin rescue regimen after two Helicobacter pylori treatment failures.
BACKGROUND
In patients with a first eradication failure, a second (rescue) therapy still fails in > 20% of cases.


OBJECTIVE
To compare rifabutin and levofloxacin rescue regimens in patients with two consecutive Helicobacter pylori eradication failures.


METHODS
Patients, in whom first treatment with omeprazole-clarithromycin-amoxicillin and a second trial with omeprazole-bismuth-tetracycline-metronidazole (or ranitidine bismuth citrate with these antibiotics) had failed, received 10 days of treatment with either rifabutin (150 mg b.d.) or levofloxacin (500 mg b.d.), plus amoxicillin (1 g b.d.) and omeprazole (20 mg b.d.). Cure rates were evaluated by the (13)C-urea breath test.


RESULTS
Twenty patients received rifabutin, and 20 levofloxacin. All the patients returned for follow-up. Compliance in the rifabutin group was 100%. Four patients in the levofloxacin group did not take the medication correctly (in two cases due to adverse effects: myalgia and rash). Side effects in the rifabutin and levofloxacin groups were reported in 60% and 50% of the cases, respectively. Five patients (25%) treated with rifabutin presented with leucopenia, and six (30%) treated with levofloxacin presented with myalgias. Per-protocol cure rates were 45% (95% confidence interval, 26-66%) in the rifabutin group, and 81% (57-93%) in the levofloxacin group (P < 0.05). Intention-to-treat cure rates were, 45% (26-66%) and 85% (64-95%), respectively (P < 0.01).


CONCLUSIONS
After two previous H. pylori eradication failures, a 10-day triple levofloxacin-based rescue regimen is more effective than the same regimen with rifabutin.
Gisbert
J P
JP
Department of Gastroenterology, La Princesa University Hospital, Universidad Autónoma, Madrid, Spain. gisbert@meditex.es
Gisbert
J L
JL
Marcos
S
S
Moreno-Otero
R
R
Pajares
J M
JM
D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D016481:Helicobacter Infections / Q000188:drug therapy*; D016480:Helicobacter pylori / Q000187:drug effects*; D006801:Humans; D064704:Levofloxacin; D008297:Male; D008875:Middle Aged; D015242:Ofloxacin / Q000627:therapeutic use*; D017828:Rifabutin / Q000627:therapeutic use*; D017211:Treatment Failure
D000900:Anti-Bacterial Agents; D017828:Rifabutin; D064704:Levofloxacin; D015242:Ofloxacin