title: First- and second-lineHelicobacter pylorieradication with modified sequential therapy and modified levofloxacin-amoxicillin-based triple therapy.
abstract: BACKGROUND
  Helicobacter pylori (H. pylori) treatment remains a challenge for physicians. Although highly effective, the standard sequential therapy fails in a certain number of patients. Moreover, the cure rate following a levofloxacin-amoxicillin second-line triple therapy seems to be decreasing. We tested the efficacy of modified 10-day sequential therapy, and an intensified levofloxacin-amoxicillin regimen as first- and second-line therapy respectively.
  
  
  METHODS
  In this prospective, open label, multicenter, pilot studyH. pylori-infected patients received a first-line modified 10-day sequential therapy regimen including rabeprazole 20 mg, and amoxicillin 1 g for the first 3 days, followed by rabeprazole 20 mg, clarithromycin 250 mg, and metronidazole 250 mg, for the remaining 7 days, all drugs given thrice daily. An 8-day therapy regimen with rabeprazole 20 mg, levofloxacin 250 mg, and amoxicillin 1 g, all thrice daily, was administered a second-line therapy.
  
  
  RESULTS
  A total of 99 and 15 patients were enrolled for first- and second-line therapy. The eradication rates were 85.9% (95% CI 80-93) and 93.4% (95% CI 88-98) according to ITT and PP analyses following modified sequential therapy, and 60% (95% CI 35-86) and 64.3% (95% CI 39-89) following the intensified second-line therapy.
  
  
  CONCLUSIONS
  A modified sequential 3- plus 7-day regimen with thrice daily drug administration failed to achieve very high eradication rate at ITT analysis. The intensified second-line regimen achieved disappointingly low eradication rate. Novel levofloxacin-free second-line therapies are urged in Italy.
authors.affiliation: Gastroenterology and Digestive Endoscopy, "Nuovo Regina Margherita" Hospital Rome (Angelo Zullo, Cesare Hassan), Italy.
authors.forename: Angelo
authors.initials: A
authors.lastname: Zullo
authors.affiliation: Gastroenterology Unit, Sapienza University of Rome, "Polo Pontino" Hospital, Latina (Lorenzo Ridola, Domenico Alvaro), Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Ridola
authors.affiliation: Gastroenterology and Digestive Endoscopy, Israelitic Hospital, Rome (Cesare Efrati, Giorgia Nikolini, Claudio Cannaviello), Italy.
authors.forename: Cesare
authors.initials: C
authors.lastname: Efrati
authors.affiliation: Endoscopy Unit, Ruiniti Hospital, Foggia (Floriana Giorgio, Vincenzo De Francesco), Italy.
authors.forename: Floriana
authors.initials: F
authors.lastname: Giorgio
authors.affiliation: Gastroenterology and Digestive Endoscopy, Israelitic Hospital, Rome (Cesare Efrati, Giorgia Nikolini, Claudio Cannaviello), Italy.
authors.forename: Giorgia
authors.initials: G
authors.lastname: Nicolini
authors.affiliation: Gastroenterology and Digestive Endoscopy, Israelitic Hospital, Rome (Cesare Efrati, Giorgia Nikolini, Claudio Cannaviello), Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Cannaviello
authors.affiliation: Gastroenterology Unit, Sapienza University of Rome, "Polo Pontino" Hospital, Latina (Lorenzo Ridola, Domenico Alvaro), Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: Alvaro
authors.affiliation: Gastroenterology and Digestive Endoscopy, "Nuovo Regina Margherita" Hospital Rome (Angelo Zullo, Cesare Hassan), Italy.
authors.forename: Cesare
authors.initials: C
authors.lastname: Hassan
authors.affiliation: Gastroenterology and Digestive Endoscopy; "Versilia" Hospital, Lido di Camaiore (Luigi Gatta), Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Gatta
authors.affiliation: Endoscopy Unit, Ruiniti Hospital, Foggia (Floriana Giorgio, Vincenzo De Francesco), Italy.
authors.forename: Vincenzo De
authors.initials: VD
authors.lastname: Francesco
keywords: Helicobacter pylori; modified levofloxacin triple therapy; modified sequential therapy; second-line therapy; sequential therapy; therapy