Original Contribution
The American Journal of Gastroenterology (2006) 101, 243–247; doi:10.1111/j.1572-0241.2006.00457.x
Third-Line Rescue Therapy with Levofloxacin After Two H. pylori Treatment Failures
Javier P Gisbert MD1, Manuel Castro-Fernández MD2, Fernando Bermejo MD3, Angeles Pérez-Aisa MD4, Julio Ducons MD5, Miguel Fernández-Bermejo MD6, Felipe Bory MD7, Angel Cosme MD8, Luis-Miguel Benito MD9, Laureano López-Rivas MD10, Eloisa Lamas MD2, Manuel Pabón MD2 and David Olivares MD1 The H. pylori Study Group of the Asociación Española de Gastroenterología
- 1Hospital de la Princesa, Madrid, Spain
- 2Hospital de Valme, Sevilla, Spain
- 3Hospital de Fuenlabrada, Madrid, Spain
- 4Hospital Costa del Sol, Málaga, Spain
- 5Hospital San Jorge, Huesca, Spain
- 6Hospital San Pedro de Alcántara, Cáceres, Spain
- 7Hospital del Mar, Barcelona, Spain
- 8Hospital de Donostia, San Sebastián, Spain
- 9Hospital Virgen del Toro, Menorca Spain
- 10Hospital de San Agustín, Asturias, Spain
Correspondence: Javier P Gisbert, MD, Playa de Mojácar 29, Urb. Bonanza, 28669 Boadilla del Monte, Madrid, Spain.
Received 22 August 2005; Accepted 2 October 2005.
Abstract
AIM:
Eradication therapy with proton pump inhibitor, clarithromycin and amoxicillin fails in a considerable number of cases. A rescue therapy still fails in more than 20% of the cases. Our aim was to evaluate the efficacy and tolerability of a third-line levofloxacin-based regimen in patients with two consecutive Helicobacter pylori eradication failures.
METHODS:
Design: Prospective multicenter study. Patients: In whom a first treatment with omeprazole-clarithromycin-amoxicillin and a second with omeprazole-bismuth-tetracycline-metronidazole (or ranitidine bismuth citrate with these antibiotics) had failed. Intervention: A third eradication regimen with levofloxacin (500 mg b.i.d.), amoxicillin (1 g b.i.d.), and omeprazole (20 mg b.i.d.) was prescribed for 10 days. Outcome: Eradication was confirmed with 13C-urea breath test 4–8 wk after therapy.
RESULTS:
One-hundred patients were initially included, and nine were lost for follow-up. All patients but five took all the medications correctly. Per-protocol and intention-to-treat eradication rates were 66% (95% CI = 56–75%) and 60% (50–70%). Adverse effects were reported in 25% of the patients, mainly including metallic taste (8%), nausea (8%), myalgia/arthralgia (5%), and diarrhea (4%); none of them were severe.
CONCLUSION:
Levofloxacin-based rescue therapy constitutes an encouraging empirical third-line strategy after multiple previous H. pylori eradication failures with key antibiotics such as amoxicillin, clarithromycin, metronidazole, and tetracycline.
