title: Levofloxacin, bismuth, amoxicillin and esomeprazole as second-line Helicobacter pylori therapy after failure of non-bismuth quadruple therapy.
abstract: BACKGROUND
  The best rescue therapy for Helicobacter pylori (H. pylori) infection following failure of non-bismuth quadruple therapy (NBQT) remains unanswered.
  
  
  OBJECTIVE
  To determine the efficacy, safety and compliance of levofloxacin, bismuth, amoxicillin and esomeprazole (LBAE) regimen following failure of NBQT.
  
  
  METHODS
  132 patients with H. pylori infection refractory to first-line NBQT received LBAE regimen (levofloxacin 500mg once/day, bismuth potassium citrate 220mg twice/day, amoxicillin 1000mg twice/day and esomeprazole 20mg twice/day for 14 days). Gastric mucosal biopsy was obtained for H. pylori culture, antimicrobial sensitivity test and cytochrome P450 isoenzyme 2C19 polymorphism analysis.
  
  
  RESULTS
  LBAE therapy achieved eradication rates of 73.5% [95% confidence intervals (CI) 65.9-81.1%] in intention-to-treat and 78.5% (71.1-85.9%) in per-protocol analyses in patients with high antibiotic resistance (amoxicillin 8.3%, clarithromycin 55.6%, metronidazole 73.6% and levofloxacin 36.1%). Adverse effects were found in 19.2% and compliance in 96.1% of the treated patients. Multivariate analyses identified levofloxacin resistance [odds ratio (OR) 7.183, 95% CI 1.616-31.914, P=0.010] and history of quinolone intake (4.844, 1.174-19.983, P=0.029) as independent predictors of treatment failure. The eradication rate of patients with dual amoxicillin and levofloxacin resistance was significantly decreased (33.3%, P=0.006).
  
  
  CONCLUSIONS
  In populations with high levofloxacin resistance, 14-day second-line LBAE regimen resulted in an unsatisfactory efficacy in patients resistant to NBQT despite good safety and compliance.
authors: Department of Gastroenterology, Peking University Third Hospital, Beijing, China.
authors: Zhiqiang
authors: Z
authors: Song
authors: Department of Gastroenterology, Peking University Third Hospital, Beijing, China. Electronic address: zhouliya123456@163.com.
authors: Liya
authors: L
authors: Zhou
authors: State Key Laboratory for Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
authors: Jianzhong
authors: J
authors: Zhang
authors: State Key Laboratory for Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
authors: Lihua
authors: L
authors: He
authors: Department of Gastroenterology, Peking University Third Hospital, Beijing, China.
authors: Peng
authors: P
authors: Bai
authors: Department of Gastroenterology, Peking University Third Hospital, Beijing, China.
authors: Yan
authors: Y
authors: Xue
mesh_terms: D000328:Adult; D000658:Amoxicillin / Q000494:pharmacology / Q000627:therapeutic use*; D000863:Antacids / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001729:Bismuth / Q000627:therapeutic use*; D017291:Clarithromycin / Q000494:pharmacology; D065731:Cytochrome P-450 CYP2C19 / Q000235:genetics; D024901:Drug Resistance, Multiple, Bacterial; D004359:Drug Therapy, Combination / Q000009:adverse effects; D064098:Esomeprazole / Q000378:metabolism / Q000627:therapeutic use*; D005260:Female; D016481:Helicobacter Infections / Q000188:drug therapy* / Q000235:genetics; D016480:Helicobacter pylori / Q000187:drug effects; D006801:Humans; D064704:Levofloxacin / Q000494:pharmacology / Q000627:therapeutic use*; D008297:Male; D055118:Medication Adherence; D008795:Metronidazole / Q000494:pharmacology; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D011446:Prospective Studies; D054328:Proton Pump Inhibitors / Q000378:metabolism / Q000627:therapeutic use; D019233:Retreatment; D016896:Treatment Outcome
chemical_list: D000863:Antacids; D000900:Anti-Bacterial Agents; D054328:Proton Pump Inhibitors; D008795:Metronidazole; D064704:Levofloxacin; D000658:Amoxicillin; D065731:Cytochrome P-450 CYP2C19; D017291:Clarithromycin; D064098:Esomeprazole; D001729:Bismuth
keywords: Bismuth; Eradication; Helicobacter pylori; Levofloxacin; Non-bismuth quadruple therapy; Second-line