Efficacy of levofloxacin, amoxicillin and a proton pump inhibitor in the eradication of Helicobacter pylori in Brazilian patients with peptic ulcers

Abstract

OBJECTIVES:The eradication of Helicobacter (H.) pylori allows peptic ulcers in patients infected with the bacteria to be cured. Treatment with the classic triple regimen (proton pump inhibitor, amoxicillin and clarithromycin) has shown decreased efficacy due to increased bacterial resistance to clarithromycin. In our country, the eradication rate by intention to treat with this regimen is 83%. In Brazil, a commercially available regimen for bacterial eradication that uses levofloxacin and amoxicillin with lansoprazole is available; however, its efficacy is not known. Considering that such a treatment may be an alternative to the classic regimen, we aimed to verify its efficacy in H. pylori eradication.METHODS:Patients with peptic ulcer disease infected with H. pylori who had not received prior treatment were treated with the following regimen: 30 mg lansoprazole bid, 1,000 mg amoxicillin bid and 500 mg levofloxacin, once a day for 7 days.RESULTS:A total of 66 patients were evaluated. The patients’ mean age was 52 years, and women comprised 55% of the sample. Duodenal ulcers were present in 50% of cases, and gastric ulcers were present in 30%. The eradication rate was 74% per protocol and 73% by intention to treat. Adverse effects were reported by 49 patients (74%) and were mild to moderate, with a prevalence of diarrhea complaints.CONCLUSIONS:Triple therapy comprising lansoprazole, amoxicillin and levofloxacin for 7 days for the eradication of H. pylori in Brazilian peptic ulcer patients showed a lower efficacy than that of the classic triple regimen.

Levofloxacin versus clarithromycin for Helicobacter pylori eradication: are 14 day regimens better than 10 day regimens?

“…Discrepancies between trial results could be also attributed to ethnic differences, although drug dosage and treatment duration should also be considered. Such impact was suggested by Silva et al who conducted a study on 66 Brazilian patients who had H. pylori infection, did not receive prior treatment, and were treated with levofloxacin triple-based regimen (levofloxacin, amoxicillin, and lansoprazole) showed an eradication rate of 73% (95% CI, 62–84%) compared with 82.7% (95% CI, 79–86%) reported with classic regimen of clarithromycin, amoxicillin, and a PPI [ 17 ]. This finding could be explained by an earlier Brazilian study that found higher rates of resistance by H. pylori to levofloxacin (23%) than to clarithromycin (8%) [ 18 ].…”

Helicobacter pyloriMutations Conferring Resistance to Fluoroquinolones and Clarithromycin among Dyspeptic Patients Attending a Tertiary Hospital, Tanzania

“…The highest rate in Africa has been reported in Congo Brazzaville [12, 33, 44]; however in the current study, about 59% of patients studied carried known fluoroquinolones resistance mutations. Quinolone resistance to H. pylori has been associated with second line treatment failure [20]; therefore these findings are alarming because a significant proportion of patients on the second line regimen might have treatment failure. This could be explained by the fact that in Tanzania quinolones are commonly used in the treatment of urinary tract infections, typhoid fever, infectious diarrhea, and genital discharge syndrome, hence selecting for H. pylori resistant strains.…”

“…Second line regimen includes quinolone based therapy which is alternative after failure of first line regimen. Quinolone resistance to H. pylori has been associated with second line treatment failure in 27% of patients [20]. A mutation in the quinolone-resistance-determining region (QRDR) is responsible for the resistance to quinolones.…”