title: Low efficacy of levofloxacin-doxycycline-based third-line triple therapy for Helicobacter pylori eradication in Italy.
abstract: OBJECTIVE
  To evaluate a levofloxacin-doxycycline-based triple therapy with or without a susceptibility culture test in non-responders to Helicobacter pylori (H. pylori) eradication.
  
  
  METHODS
  A total of 142 (99 women, 43 men; mean 53.0 ± 12.7 years) non-responders to more than two H. pylori eradication therapies underwent susceptibility culture tests or were treated with a seven-day triple therapy consisting of esomeprazole, 20 mg b.i.d., levofloxacin, 500 mg b.i.d., and doxycycline, 100 mg b.i.d., randomly associated with (n = 71) or without (n = 71) Lactobacillus casei DG. H. pylori status was checked in all patients at enrollment and at least 8 wk after the end of therapy. Compliance and tolerability of regimens were also assessed.
  
  
  RESULTS
  H. pylori eradication was achieved in < 50% of patients [per prototol (PP) = 49%; intention to treat (ITT) = 46%]. Eradication rate was higher in patients administered probiotics than in those without (PP = 55% vs 43%; ITT = 54% vs 40%). Estimated primary resistance to levofloxacin was 18% and multiple resistance was 31%. Therapy was well tolerated, and side effects were generally mild, with only one patient experiencing severe effects.
  
  
  CONCLUSIONS
  Third-line levofloxacin-doxycycline triple therapy had a low H. pylori eradication efficacy, though the success and tolerability of this treatment may be enhanced with probiotics.
authors.affiliation: Omero Alessandro Paoluzi, Giovanna Del Vecchio Blanco, Emanuela Visconti, Manuela Coppola, Francesco Pallone, Gastroenterology Unit, Department of Internal Medicine, University Tor Vergata, 00133 Roma, Italy.
authors.forename: Omero Alessandro
authors.initials: OA
authors.lastname: Paoluzi
authors.affiliation: Omero Alessandro Paoluzi, Giovanna Del Vecchio Blanco, Emanuela Visconti, Manuela Coppola, Francesco Pallone, Gastroenterology Unit, Department of Internal Medicine, University Tor Vergata, 00133 Roma, Italy.
authors.forename: Giovanna
authors.initials: G
authors.lastname: Del Vecchio Blanco
authors.affiliation: Omero Alessandro Paoluzi, Giovanna Del Vecchio Blanco, Emanuela Visconti, Manuela Coppola, Francesco Pallone, Gastroenterology Unit, Department of Internal Medicine, University Tor Vergata, 00133 Roma, Italy.
authors.forename: Emanuela
authors.initials: E
authors.lastname: Visconti
authors.affiliation: Omero Alessandro Paoluzi, Giovanna Del Vecchio Blanco, Emanuela Visconti, Manuela Coppola, Francesco Pallone, Gastroenterology Unit, Department of Internal Medicine, University Tor Vergata, 00133 Roma, Italy.
authors.forename: Manuela
authors.initials: M
authors.lastname: Coppola
authors.affiliation: Omero Alessandro Paoluzi, Giovanna Del Vecchio Blanco, Emanuela Visconti, Manuela Coppola, Francesco Pallone, Gastroenterology Unit, Department of Internal Medicine, University Tor Vergata, 00133 Roma, Italy.
authors.forename: Carla
authors.initials: C
authors.lastname: Fontana
authors.affiliation: Omero Alessandro Paoluzi, Giovanna Del Vecchio Blanco, Emanuela Visconti, Manuela Coppola, Francesco Pallone, Gastroenterology Unit, Department of Internal Medicine, University Tor Vergata, 00133 Roma, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Favaro
authors.affiliation: Omero Alessandro Paoluzi, Giovanna Del Vecchio Blanco, Emanuela Visconti, Manuela Coppola, Francesco Pallone, Gastroenterology Unit, Department of Internal Medicine, University Tor Vergata, 00133 Roma, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Pallone
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000009:adverse effects; D004318:Doxycycline / Q000008:administration & dosage* / Q000009:adverse effects; D004334:Drug Administration Schedule; D024901:Drug Resistance, Multiple, Bacterial; D004359:Drug Therapy, Combination; D064098:Esomeprazole / Q000008:administration & dosage; D005260:Female; D016481:Helicobacter Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology; D016480:Helicobacter pylori / Q000187:drug effects* / Q000472:pathogenicity; D006801:Humans; D007558:Italy; D007780:Lacticaseibacillus casei / Q000254:growth & development; D064704:Levofloxacin / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D055118:Medication Adherence; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D019936:Probiotics / Q000627:therapeutic use; D054328:Proton Pump Inhibitors / Q000008:administration & dosage; D012074:Remission Induction; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D054328:Proton Pump Inhibitors; D064704:Levofloxacin; D004318:Doxycycline; D064098:Esomeprazole
keywords: Doxycycline; Eradication therapy; Esomeprazole; Helicobacter pylori; Levofloxacin; Urea breath test