[Efficacy of levofloxacin-based triple therapy as second-line Helicobacter pylori eradication].
OBJECTIVE
Bismuth-based quadruple therapy for second-line eradication treatment achieves the eradication rate ranging from 70% to 81% due to antimicrobial resistance and poor compliance. The aim of this study was to compare the eradication rate of levofloxacin-based triple therapy with that of bismuth-based quadruple therapy in second-line Helicobacter pylori (H. pylori) eradication therapy.


METHODS
Seventy-six outpatients with persistent H. pylori infection after first-line triple therapy were enrolled in this prospective randomized trial. The subjects were randomized to receive levofloxacin 300 mg, amoxicillin 1 g, and pantoprazole 20 mg, given twice daily for 7 days (LAP group), or metronidazole 500 mg twice, tetracycline 500 mg four times, and pantoprazole 20 mg twice, bismuth subcitrate 600 mg twice daily for 7 days (MTPB group). Eradication was confirmed with (13)C-urea breath test or rapid urease test 4 weeks after the cessation of therapy.


RESULTS
Among Seventy-six patients initially included, eleven were lost during follow-up. The eradication rates, expressed as intention to treat (ITT) and per protocol (PP) analyses, were 51.6% and 53.3% in the LAP group, and 48.9% and 62.9% in the MTPB group, respectively. There was no significant difference in H. pylori eradication rates between the two groups (p=0.815 by ITT, p=0.437 by PP). LAP regimen was better tolerated than MTPB regimen with lower incidence of side effects (10.0% versus 31.4%, p=0.03).


CONCLUSIONS
H. pylori eradication rates of levofloxacin-based triple therapy and bismuth-based quadruple therapy were not significantly different in second-line H. pylori eradication therapy, and low incidence of side effects was observed in levofloxacin-based triple therapy.
Department of Internal Medicine, Ewha Medical Research Institute, School of Medicine, Ewha Womans University, Yangcheon-gu, Seoul, Korea.
Hae Sun
HS
Jung
Ki-Nam
KN
Shim
Su Jung
SJ
Baik
Youn Ju
YJ
Na
Min-Jung
MJ
Kang
Ji Min
JM
Jung
Chang Yoon
CY
Ha
Sung-Ae
SA
Jung
Kwon
K
Yoo
D053799:2-Pyridinylmethylsulfinylbenzimidazoles / Q000008:administration & dosage; D000328:Adult; D000863:Antacids / Q000008:administration & dosage; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D000897:Anti-Ulcer Agents / Q000008:administration & dosage; D003627:Data Interpretation, Statistical; D004359:Drug Therapy, Combination; D005260:Female; D016481:Helicobacter Infections / Q000188:drug therapy* / Q000382:microbiology; D016480:Helicobacter pylori; D006801:Humans; D064704:Levofloxacin; D008297:Male; D008875:Middle Aged; D015242:Ofloxacin / Q000008:administration & dosage*; D009942:Organometallic Compounds / Q000008:administration & dosage; D000077402:Pantoprazole; D013997:Time Factors; D016896:Treatment Outcome
D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000863:Antacids; D000900:Anti-Bacterial Agents; D000897:Anti-Ulcer Agents; D009942:Organometallic Compounds; D064704:Levofloxacin; D015242:Ofloxacin; D000077402:Pantoprazole; C002791:bismuth tripotassium dicitrate