Second-line and rescue therapies for Helicobacter pylori eradication in clinical practice.
OBJECTIVE
A levofloxacin-based triple therapy and a rifabutin-based regimen are advised as second-line and rescue therapies in the current Italian guidelines for H. pylori eradication. However, no data are available for the efficacy of these treatments in clinical practice.


METHODS
A total of 86 consecutive patients who failed a standard, first-line, triple therapy for H. pylori infection were treated with a 10-day triple therapy including omeprazole 20 mg, amoxycillin 1 g, and levofloxacin 250 mg or 500 mg, each given twice daily. Eradication failure patients received a 10-day rescue therapy with omeprazole 20 mg, amoxycillin 1 g, and rifabutin 150 mg, each given twice daily. A further therapeutic attempt was performed with a 14-day, high-dose dual therapy (esomeprazole 40 mg and amoxicillin 1 g, each thrice daily).


RESULTS
Following the second-line therapy, H. pylori infection was cured in 76.4% (95% CI = 67.8-85.0) and 79.5% (95% CI = 70.8-88.2) at intention-to-treat (ITT) and per-protocol (PP) analysis, respectively. After the rescue therapy, bacterial eradication was achieved in 84.6% (95% CI = 65-100). Two patients with persistent infection were successfully cured with the high-dose dual therapy.


CONCLUSIONS
The efficacy of levofloxacin-based second-line therapy seems to be decreasing, whilst rescue therapy with rifabutin would appear a valid third-line therapy, and a high-dose dual therapy may be used as a further rescue therapy.
Zullo
Angelo
A
Gastroenterology and Digestive Endoscopy, Nuovo Regina Margherita Hospital, Rome, Italy. zullo66@yahoo.it
De Francesco
Vincenzo
V
Manes
Gianpiero
G
Scaccianoce
Giuseppe
G
Cristofari
Francesca
F
Hassan
Cesare
C
D000368:Aged; D000658:Amoxicillin / Q000008:administration & dosage* / Q000009:adverse effects; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000009:adverse effects; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D064098:Esomeprazole; D005260:Female; D016481:Helicobacter Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology; D016480:Helicobacter pylori / Q000187:drug effects*; D006801:Humans; D007558:Italy; D064704:Levofloxacin; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D015242:Ofloxacin / Q000008:administration & dosage* / Q000009:adverse effects; D009853:Omeprazole / Q000008:administration & dosage* / Q000009:adverse effects; D017410:Practice Guidelines as Topic; D054328:Proton Pump Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D017828:Rifabutin / Q000008:administration & dosage* / Q000009:adverse effects; D013997:Time Factors; D017211:Treatment Failure
D000900:Anti-Bacterial Agents; D054328:Proton Pump Inhibitors; D017828:Rifabutin; D064704:Levofloxacin; D000658:Amoxicillin; D015242:Ofloxacin; D009853:Omeprazole; D064098:Esomeprazole