title: Helicobacter pylori second-line rescue therapy with levofloxacin- and bismuth-containing quadruple therapy, after failure of standard triple or non-bismuth quadruple treatments.
abstract: BACKGROUND
  The most commonly used second-line Helicobacter pylori eradication regimens are bismuth-containing quadruple therapy and levofloxacin-containing triple therapy, both offering suboptimal results. Combining bismuth and levofloxacin may enhance the efficacy of rescue eradication regimens.
  
  
  OBJECTIVE
  To evaluate the efficacy and tolerability of a second-line quadruple regimen containing levofloxacin and bismuth in patients whose previous H. pylori eradication treatment failed.
  
  
  METHODS
  This was a prospective multicenter study including patients in whom a standard triple therapy (PPI-clarithromycin-amoxicillin) or a non-bismuth quadruple therapy (PPI-clarithromycin-amoxicillin-metronidazole, either sequential or concomitant) had failed. Esomeprazole (40 mg b.d.), amoxicillin (1 g b.d.), levofloxacin (500 mg o.d.) and bismuth (240 mg b.d.) was prescribed for 14 days. Eradication was confirmed by (13) C-urea breath test. Compliance was determined through questioning and recovery of empty medication envelopes. Incidence of adverse effects was evaluated by questionnaires.
  
  
  RESULTS
  200 patients were included consecutively (mean age 47 years, 67% women, 13% ulcer). Previous failed therapy included: standard clarithromycin triple therapy (131 patients), sequential (32) and concomitant (37). A total of 96% took all medications correctly. Per-protocol and intention-to-treat eradication rates were 91.1% (95%CI = 87-95%) and 90% (95%CI = 86-94%). Cure rates were similar regardless of previous (failed) treatment or country of origin. Adverse effects were reported in 46% of patients, most commonly nausea (17%) and diarrhoea (16%); 3% were intense but none was serious.
  
  
  CONCLUSIONS
  Fourteen-day bismuth- and levofloxacin-containing quadruple therapy is an effective (≥90% cure rate), simple and safe second-line strategy in patients whose previous standard triple or non-bismuth quadruple (sequential or concomitant) therapies have failed.
authors.affiliation: Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.
authors.forename: J P
authors.initials: JP
authors.lastname: Gisbert
authors.forename: M
authors.initials: M
authors.lastname: Romano
authors.forename: A G
authors.initials: AG
authors.lastname: Gravina
authors.forename: P
authors.initials: P
authors.lastname: Solís-Muñoz
authors.forename: F
authors.initials: F
authors.lastname: Bermejo
authors.forename: J
authors.initials: J
authors.lastname: Molina-Infante
authors.forename: M
authors.initials: M
authors.lastname: Castro-Fernández
authors.forename: J
authors.initials: J
authors.lastname: Ortuño
authors.forename: A J
authors.initials: AJ
authors.lastname: Lucendo
authors.forename: M
authors.initials: M
authors.lastname: Herranz
authors.forename: I
authors.initials: I
authors.lastname: Modolell
authors.forename: F
authors.initials: F
authors.lastname: Del Castillo
authors.forename: J
authors.initials: J
authors.lastname: Gómez
authors.forename: J
authors.initials: J
authors.lastname: Barrio
authors.forename: B
authors.initials: B
authors.lastname: Velayos
authors.forename: B
authors.initials: B
authors.lastname: Gómez
authors.forename: J L
authors.initials: JL
authors.lastname: Domínguez
authors.forename: A
authors.initials: A
authors.lastname: Miranda
authors.forename: M
authors.initials: M
authors.lastname: Martorano
authors.forename: A
authors.initials: A
authors.lastname: Algaba
authors.forename: M
authors.initials: M
authors.lastname: Pabón
authors.forename: T
authors.initials: T
authors.lastname: Angueira
authors.forename: L
authors.initials: L
authors.lastname: Fernández-Salazar
authors.forename: A
authors.initials: A
authors.lastname: Federico
authors.forename: A C
authors.initials: AC
authors.lastname: Marín
authors.forename: A G
authors.initials: AG
authors.lastname: McNicholl
mesh_terms: D000328:Adult; D000368:Aged; D000658:Amoxicillin / Q000008:administration & dosage / Q000627:therapeutic use*; D000863:Antacids / Q000008:administration & dosage / Q000627:therapeutic use*; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D000930:Antidiarrheals / Q000627:therapeutic use; D001729:Bismuth / Q000008:administration & dosage / Q000627:therapeutic use*; D001944:Breath Tests; D004359:Drug Therapy, Combination; D064098:Esomeprazole / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D016481:Helicobacter Infections / Q000188:drug therapy; D006801:Humans; D064704:Levofloxacin / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D054328:Proton Pump Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D014508:Urea / Q000032:analysis
chemical_list: D000863:Antacids; D000900:Anti-Bacterial Agents; D000930:Antidiarrheals; D054328:Proton Pump Inhibitors; D064704:Levofloxacin; D000658:Amoxicillin; D014508:Urea; D064098:Esomeprazole; D001729:Bismuth