title: An alternative salvage regimen for Helicobacter pylori-resistant patients with heart failure.
abstract: Helicobacter pylori infects over 50% of the worldwide population. For eradication, European, Canadian, and American guidelines recommend a regimen consisting of a proton pump inhibitor, clarithromycin, and metronidazole or amoxicillin dosed twice daily for at least 7 days. When this treatment strategy fails, a complex, multidosed bismuth-based quadruple regimen is recommended. Unfortunately, for patients with heart failure, this salvage regimen can be potentially hazardous due to the drug-drug interaction with tetracycline and digoxin, as well as the large salicylate content with bismuth subsalicylate. As H. pylori infection is so prevalent, providers will most likely encounter such a therapeutic dilemma. A safe, effective, and simplistic alternative is a 10-day fluoroquinolone-based regimen consisting of a proton pump inhibitor, levofloxacin and either clarithromycin or amoxicillin. Levofloxacin demonstrates excellent bioavailability, widespread tissue and fluid distribution, extended half-life, limited drug interaction profile, low incidence of side effects, and remarkable activity against H. pylori with minimal primary resistance. Compared to the 7-day quadruple regimen, a 10-day levofloxacin-based regimen demonstrated a greater eradication rate, better tolerability, and a lower rate of therapy discontinuation. We briefly provide a summary of the data regarding this levofloxacin-based regimen and two successful cases from our heart failure clinic.
authors.affiliation: Department of Clinical Pharmacy, UCHSC, Schools of Pharmacy and Medicine, Denver, CO 80262, USA. robert.page@uchsc.edu
authors.forename: Robert Lee
authors.initials: RL
authors.lastname: Page
authors.forename: Debra
authors.initials: D
authors.lastname: Ferguson
authors.forename: Mona
authors.initials: M
authors.lastname: Cantu
mesh_terms: D000658:Amoxicillin / Q000008:administration & dosage; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D015897:Comorbidity; D004359:Drug Therapy, Combination; D006333:Heart Failure / Q000453:epidemiology*; D016481:Helicobacter Infections / Q000188:drug therapy* / Q000453:epidemiology*; D016480:Helicobacter pylori; D006801:Humans; D064704:Levofloxacin; D008297:Male; D008875:Middle Aged; D015242:Ofloxacin / Q000008:administration & dosage; D009853:Omeprazole / Q000008:administration & dosage; D054328:Proton Pump Inhibitors / Q000008:administration & dosage
chemical_list: D000900:Anti-Bacterial Agents; D054328:Proton Pump Inhibitors; D064704:Levofloxacin; D000658:Amoxicillin; D015242:Ofloxacin; D009853:Omeprazole