Second-line levofloxacin-based triple schemes for Helicobacter pylori eradication

S. Di Caro, F. Franceschi, A. Mariani, F. Thompson, D. Raimondo, E. Masci, A. Testoni, E. La Rocca, A. Gasbarrini

Research output: Contribution to journalArticle

Abstract

Background: The recommended second-line therapy for Helicobacter pylori (H. pylori) eradication is a quadruple regimen that fails in up to 30% of patients. Several recent studies suggest levofloxacin-based triple therapies as an alternative rescue treatment. However, dosage and length of levofloxacin-based regimens have not been established. Aim: To compare the efficacy and tolerability of four second-line levofloxacin-based schemes for H. pylori eradication. Methods: One hundred and sixty patients (aged 18-70 years, 72 male patients) who were H. pylori positive after standard triple therapies were randomised to receive esomeprazole 20 mg b.d. and amoxicillin 1 g b.d. plus levofloxacin 500 mg o.d., for 7 or 10 days (Groups A and B) or levofloxacin 500 mg b.d. for 7 days or 10 days (Groups C and D). H. pylori status was assessed by 13-C Urea Breath Test or rapid urease test, before and 6 weeks after therapy. Incidence of side effects was evaluated by a questionnaire. Results: No dropouts were observed. Eradication of H. pylori infection was successful in: 65% of patients in Group A; 90% in Group B; 70% in Group C; 85% in Group D. Based upon duration of treatment, eradication rates were: 67.5% in 7 days groups and 87.5% in 10 days groups (p = 0.004). Dosage of levofloxacin did not affect the eradication rates (77.5% both in the once daily and twice daily groups). Mild adverse events were reported overall in 16% of patients (22.5% in 7 days groups; 27.5% in 10 days groups; p = 0.58; 12% in the once daily group; 32.5% in the twice daily group; p = 0.04). Conclusions: 10 days levofloxacin-based second-line regimens were effective in curing H. pylori infection in more than 85% of patients with a lower incidence of adverse effects in levofloxacin single-dosage scheme. The 10 days levofloxacin-based regimens were more effective than 7 days course of treatment showing that duration of therapy is the crucial factor affecting eradication rate.

Original languageEnglish
Pages (from-to)480-485
Number of pages6
JournalDigestive and Liver Disease
Volume41
Issue number7
DOIs
Publication statusPublished - Jul 2009

Fingerprint

Levofloxacin
Helicobacter pylori
Helicobacter Infections
Therapeutics
Esomeprazole
Breath Tests
Urease
Incidence
Amoxicillin
Complementary Therapies
Urea

Keywords

  • H. pylori
  • Levofloxacin
  • Second-line treatment

ASJC Scopus subject areas

  • Gastroenterology
  • Hepatology

Cite this

Di Caro, S., Franceschi, F., Mariani, A., Thompson, F., Raimondo, D., Masci, E., ... Gasbarrini, A. (2009). Second-line levofloxacin-based triple schemes for Helicobacter pylori eradication. Digestive and Liver Disease, 41(7), 480-485. https://doi.org/10.1016/j.dld.2008.09.013

Second-line levofloxacin-based triple schemes for Helicobacter pylori eradication. / Di Caro, S.; Franceschi, F.; Mariani, A.; Thompson, F.; Raimondo, D.; Masci, E.; Testoni, A.; La Rocca, E.; Gasbarrini, A.

In: Digestive and Liver Disease, Vol. 41, No. 7, 07.2009, p. 480-485.

Research output: Contribution to journalArticle

Di Caro, S, Franceschi, F, Mariani, A, Thompson, F, Raimondo, D, Masci, E, Testoni, A, La Rocca, E & Gasbarrini, A 2009, 'Second-line levofloxacin-based triple schemes for Helicobacter pylori eradication', Digestive and Liver Disease, vol. 41, no. 7, pp. 480-485. https://doi.org/10.1016/j.dld.2008.09.013
Di Caro S, Franceschi F, Mariani A, Thompson F, Raimondo D, Masci E et al. Second-line levofloxacin-based triple schemes for Helicobacter pylori eradication. Digestive and Liver Disease. 2009 Jul;41(7):480-485. https://doi.org/10.1016/j.dld.2008.09.013
Di Caro, S. ; Franceschi, F. ; Mariani, A. ; Thompson, F. ; Raimondo, D. ; Masci, E. ; Testoni, A. ; La Rocca, E. ; Gasbarrini, A. / Second-line levofloxacin-based triple schemes for Helicobacter pylori eradication. In: Digestive and Liver Disease. 2009 ; Vol. 41, No. 7. pp. 480-485.
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AU - Masci, E.

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N2 - Background: The recommended second-line therapy for Helicobacter pylori (H. pylori) eradication is a quadruple regimen that fails in up to 30% of patients. Several recent studies suggest levofloxacin-based triple therapies as an alternative rescue treatment. However, dosage and length of levofloxacin-based regimens have not been established. Aim: To compare the efficacy and tolerability of four second-line levofloxacin-based schemes for H. pylori eradication. Methods: One hundred and sixty patients (aged 18-70 years, 72 male patients) who were H. pylori positive after standard triple therapies were randomised to receive esomeprazole 20 mg b.d. and amoxicillin 1 g b.d. plus levofloxacin 500 mg o.d., for 7 or 10 days (Groups A and B) or levofloxacin 500 mg b.d. for 7 days or 10 days (Groups C and D). H. pylori status was assessed by 13-C Urea Breath Test or rapid urease test, before and 6 weeks after therapy. Incidence of side effects was evaluated by a questionnaire. Results: No dropouts were observed. Eradication of H. pylori infection was successful in: 65% of patients in Group A; 90% in Group B; 70% in Group C; 85% in Group D. Based upon duration of treatment, eradication rates were: 67.5% in 7 days groups and 87.5% in 10 days groups (p = 0.004). Dosage of levofloxacin did not affect the eradication rates (77.5% both in the once daily and twice daily groups). Mild adverse events were reported overall in 16% of patients (22.5% in 7 days groups; 27.5% in 10 days groups; p = 0.58; 12% in the once daily group; 32.5% in the twice daily group; p = 0.04). Conclusions: 10 days levofloxacin-based second-line regimens were effective in curing H. pylori infection in more than 85% of patients with a lower incidence of adverse effects in levofloxacin single-dosage scheme. The 10 days levofloxacin-based regimens were more effective than 7 days course of treatment showing that duration of therapy is the crucial factor affecting eradication rate.

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