A 10‐day levofloxacin‐based triple therapy in patients who have failed two eradication courses

Abstract

Background: A standard third-line treatment is lacking, and European guidelines recommend performing culture in these patients. However, the use of this procedure as 'routine practice' is definitively not feasible. Aim: To evaluate the eradication rate of a 10-day levofloxacin-based triple therapy in patients who have failed two eradication courses for Helicobacter pylori. Methods: A total of 151 patients with persistent Helicobacter pylori infection after two treatments were studied. Patients were considered positive if two of three endoscopic tests were positive. Susceptibility testing was also performed. Patients received a standard dose of

“Rescue” regimens after Helicobacter pylori treatment failure

“…Furthermore, it has been shown in vitro that levofloxacin retains its activity when H pylori strains are resistant to clarithromycin and metronidazole [95,98,99] . These favorable results have been confirmed in vivo, indicating that most of the patients with both metronidazole and clarithromycin resistance are cured with the levofloxacin-based regimen [52,94,100] . A combination of a PPI, amoxicillin and levofloxacin, as a first-line regimen, has been associated with favorable results, with mean eradication rates of about 90% [95,[101][102][103][104][105][106] .…”

“…Recently, some studies have evaluated the efficacy of new fluoroquinolones, such as levofloxacin, that could prove to be a valid alternative to standard antibiotics, not only as first-line therapies, but more interestingly, as second-line regimens [21,[88][89][90] . In this respect, levofloxacin-based second-line therapies represent an encouraging strategy for eradication failures, as some studies have demonstrated that levofloxacin has, in vitro, remarkable activity against H pylori [91] , and that primary resistances to such an antibiotic are (still) relatively infrequent (when compared with metronidazole or clarithromycin) [92][93][94][95][96] . A recent in vitro study also showed a synergistic effect of quinolone antimicrobial agents and PPIs on strains of H pylori [97] .…”

“…Moreover, two metaanalyses have demonstrated a lower incidence of adverse effects with levofloxacin-based treatments than with the quadruple combinations [88,89] . Unfortunately, it has been shown that resistance to quinolones is easily acquired, and in countries with a high consumption of these drugs, the resistance rate is increasing and is already relatively high [94,103,107,[113][114][115][116][117][118][119][120][121][122][123] . More importantly, it has been demonstrated that the presence of levofloxacin resistance significantly reduce the eradication rate following a therapy with this antibiotic [94,103,121,124] .…”

“…It has been suggested that levofloxacin-based therapies may also represent an alternative when two (or more) consecutive eradication treatments have failed to eradicate the infection [52,94,118,147,154,155,[162][163][164] . As an example, a recent study by Zullo et al [147] aimed to evaluate the efficacy of a levofloxacin-amoxicillin-PPI combination in patients who previously had failed two or more therapeutic attempts, and they found the eradication rate was 83% (intention-to-treat analysis).…”

The Study of Association between Helicobacter pylori (H. pylori) and Chronic Obstructive Pulmonary Disease (COPD)

“…She said multiple regimens have been evaluated for Helicobacter pylori (H. pylori) therapy in randomized controlled trials [3,48,[75][76][77]. Despite the number of studies, the optimal therapeutic regimen has not yet been defined.…”