title: Levofloxacin, Metronidazole, and Lansoprazole Triple Therapy Compared to Quadruple Therapy as a Second-Line Treatment of Helicobacter pylori Infection in Korea.
abstract: OBJECTIVE
  Several rescue therapies have been recommended to eradicate Helicobacter pylori infection in patients with a failure of first-line eradication therapy, but they still fail in more than 20% of cases. The aim of this study was to evaluate the efficacy and safety of levofloxacin, metronidazole, and lansoprazole (LML) triple therapy relative to quadruple therapy as a second-line treatment.
  
  
  METHODS
  In total, 113 patients who failed first-line triple therapy for H. pylori infection were randomly assigned to two groups: LML for 7 days and tetracycline, bismuth subcitrate, metronidazole and lansoprazole (quadruple) for 7 days.
  
  
  RESULTS
  According to intention-to-treat analysis, the infection was eradicated in 38 of 56 patients (67.9%) in the LML group and 48 of 57 (84.2%) in the quadruple group (p=0.042). Per-protocol analysis showed successful eradication in 38 of 52 patients (73.1%) from the LML group and 48 of 52 (92.3%) from the quadruple group (p=0.010). There were no significant differences in the adverse effects in either treatment group.
  
  
  CONCLUSIONS
  LML therapy is less effective than quadruple therapy as a second-line treatment for H. pylori infection. Therefore, quadruple therapy should be considered as the primary second-line strategy for patients experiencing a failure of first-line H. pylori therapy in Korea.
authors.affiliation: Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea.
authors.forename: Ji Yoon
authors.initials: JY
authors.lastname: Moon
authors.forename: Gwang Ha
authors.initials: GH
authors.lastname: Kim
authors.forename: Hyun Seok
authors.initials: HS
authors.lastname: You
authors.forename: Bong Eun
authors.initials: BE
authors.lastname: Lee
authors.forename: Dong Yeop
authors.initials: DY
authors.lastname: Ryu
authors.forename: Jae Hoon
authors.initials: JH
authors.lastname: Cheong
authors.forename: Jung Im
authors.initials: JI
authors.lastname: Jung
authors.forename: Jae Hoon
authors.initials: JH
authors.lastname: Jeong
authors.forename: Chul Soo
authors.initials: CS
authors.lastname: Song
authors.forename: Geun Am
authors.initials: GA
authors.lastname: Song
keywords: Failure; Helicobacter pylori; Levofloxacin; Metronidazole; Therapeutics
references.citation: Aliment Pharmacol Ther. 2008 Feb 15;27(4):346-54
references.pmid: 17999716
references.citation: J Antimicrob Chemother. 2009 May;63(5):1017-24
references.pmid: 19246508
references.citation: Korean J Gastroenterol. 2006 Jul;48(1):19-24
references.pmid: 16861877
references.citation: J Gastroenterol Hepatol. 1998 Jan;13(1):1-12
references.pmid: 9737564
references.citation: Am J Gastroenterol. 2006 Mar;101(3):488-96
references.pmid: 16542284
references.citation: Dig Liver Dis. 2009 Jul;41(7):480-5
references.pmid: 18974025
references.citation: Aliment Pharmacol Ther. 1997 Oct;11(5):943-52
references.pmid: 9354205
references.citation: J Clin Gastroenterol. 2006 Sep;40(8):683-7
references.pmid: 16940878
references.citation: Ann Intern Med. 2007 Oct 16;147(8):553-62
references.pmid: 17938394
references.citation: Aliment Pharmacol Ther. 2003 Sep 15;18(6):627-33
references.pmid: 12969089
references.citation: J Med Microbiol. 2004 Nov;53(Pt 11):1123-1128
references.pmid: 15496391
references.citation: Dig Liver Dis. 2003 Oct;35(10):711-5
references.pmid: 14620620
references.citation: Korean J Gastroenterol. 2011 Dec;58(2):74-81
references.pmid: 21873821
references.citation: Therap Adv Gastroenterol. 2009 Nov;2(6):331-56
references.pmid: 21180581
references.citation: J Gastroenterol Hepatol. 2009 Oct;24(10):1587-600
references.pmid: 19788600
references.citation: Aliment Pharmacol Ther. 2002 Jun;16(6):1047-57
references.pmid: 12030945
references.citation: Aliment Pharmacol Ther. 2006 Jan 1;23(1):35-44
references.pmid: 16393278
references.citation: Korean J Gastroenterol. 2011 Apr;57(4):221-9
references.pmid: 21519175
references.citation: Clin Gastroenterol Hepatol. 2004 Nov;2(11):997-1002
references.pmid: 15551252
references.citation: Aliment Pharmacol Ther. 2006 Feb 1;23(3):421-7
references.pmid: 16423001
references.citation: Gut. 2007 Jun;56(6):772-81
references.pmid: 17170018
references.citation: Korean J Gastroenterol. 2011 Dec;58(2):67-73
references.pmid: 21873820
references.citation: Dig Liver Dis. 2005 Nov;37(11):821-5
references.pmid: 16040284
references.citation: Aliment Pharmacol Ther. 1999 Nov;13(11):1523-30
references.pmid: 10571611
references.citation: J Gastrointestin Liver Dis. 2010 Jun;19(2):131-4
references.pmid: 20593044
references.citation: Wien Klin Wochenschr. 2010 Jul;122(13-14):413-22
references.pmid: 20628905
references.citation: Eur J Gastroenterol Hepatol. 2002 Dec;14(12):1309-12
references.pmid: 12468950
references.citation: Gastroenterology. 1996 Apr;110(4):1244-52
references.pmid: 8613015
references.citation: Aliment Pharmacol Ther. 2000 Oct;14(10):1319-28
references.pmid: 11012477