Helicobacter pylori first-line treatment and rescue option containing levofloxacin in patients allergic to penicillin

Gisbert, Javier P.; Pérez-Aísa, Ángeles; Castro‐Fernández, Manuel; Barrio, Jesús; Rodrigo, Luís; Cosme, Ángel; Marcos, Santiago; Moreno–Otero, Ricardo

doi:10.1016/j.dld.2009.06.007

Cited by 53 publications

(52 citation statements)

References 37 publications

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“…Gsibert et al (16,17) reported that the eradication rate of triple therapy with omeprazole (20 mg bid), clarithromycin (500 mg bid) and metronidazole (500 mg bid) for seven days ranges from 55% to 64% (PP analyses).…”

Section: Discussionmentioning

confidence: 99%

Eradication of <i>H. pylori</i> Infection in Patients Allergic to Penicillin Using Triple Therapy with a PPI, Metronidazole and Sitafloxacin

et al. 2014

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Eradication of H. pylori in patients allergic to penicillin should be performed using regimens without penicillin derivatives. We treated a total of 28 patients allergic to penicillin with a proton pump inhibitor (PPI), metronidazole (250 mg bid) and sitafloxacin (100 mg bid) for one to two weeks. At four to eight weeks after the treatment, the patients underwent the [ 13 C]-urea breath test. The overall eradication rate was 100.0%. Mild adverse events were observed. Triple therapy with a PPI, metronidazole and sitafloxacin is well tolerated and effective for the eradication of H. pylori in patients allergic to penicillin.

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Section: Discussionmentioning

confidence: 99%

Eradication of <i>H. pylori</i> Infection in Patients Allergic to Penicillin Using Triple Therapy with a PPI, Metronidazole and Sitafloxacin

et al. 2014

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“…Such a combination should also be favored because of the extremely low rates of first and secondary resistance to amoxicillin. In the special case of patients with intolerance to penicillin, a PPI triple therapy containing a quinolone and rifabutin could be an alternative [Gisbert et al 2010.…”

Section: Discussionmentioning

confidence: 99%

Should quinolones come first in Helicobacter pylori therapy?

Berning

Krasz

Miehlke

2010

Therap Adv Gastroenterol

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New generations of fluoroquinolones, like levofloxacin and moxifloxacin, exhibit a broad-spectrum activity against Gram-positive and Gram-negative bacteria, and have been successfully introduced into the treatment of Helicobacter pylori infection. Based on a large body of evidence, current guidelines recommend the use of levofloxacin-or moxifloxacincontaining proton-pump inhibitor (PPI) triple therapies in second-line or rescue treatment of H. pylori infection. The efficacy of standard PPI triple therapies has substantially declined during the last decade, mainly due to increasing resistance against the key antibiotics clarithromycin and metronidazole. Therefore, alternative strategies for first-line therapy of H. pylori infection have been evaluated in a considerable number of clinical trials including sequential regimens, nonbismuth quadruple regimens, and quinolone-containing PPI triple therapy regimens. The aim of this paper is to summarize the current body of evidence of levofloxacin-and moxifloxacin-containing regimens in first-line treatment of H. pylori infection, and to discuss the risks and benefits of these strategies in the light of increasing resistance of H. pylori to quinolones.

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“…However, a final rescue regimen including levofloxacin cured the infection in all treated patients [Gisbert et al 2005e]. In a more recent study, it has been confirmed that a levofloxacin-containing regimen (together with omeprazole and clarithromycin) represents an encouraging second-line alternative in the presence of penicillin allergy [Gisbert et al 2009].…”

Section: Introductionmentioning

confidence: 99%

“…H. pylori eradication is a challenge in patients allergic to penicillin, especially in those who have failed a first-eradication trial with these two key antibiotics, clarithromycin and nitroimidazoles. To date, only few studies have evaluated the efficacy of H. pylori eradication treatment specifically in those patients allergic to penicillin, which constitutes a relatively common subgroup [Gisbert et al 2009Rodriguez-Torres et al 2005]. In our previous study, H. pylori infected patients allergic to penicillin failing first-line treatment with PPI-clarithromycin-metronidazole therapy received a second-line treatment with RBC, tetracycline and metronidazole, but this rescue regimen cured the infection in only 47% of the patients [Gisbert et al 2005e].…”

Section: Introductionmentioning

confidence: 99%

Review: Second-line rescue therapy of Helicobacter pylori infection

Gisbert

2009

Therap Adv Gastroenterol

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Helicobacter pylori infection is the main known cause of gastritis, gastroduodenal ulcer disease and gastric cancer. After more than 20 years of experience in H. pylori treatment, however, the ideal regimen to treat this infection has still to be found. Nowadays, apart from having to know well first-line eradication regimens, we must also be prepared to face treatment failures. Therefore, in designing a treatment strategy we should not focus on the results of primary therapy alone, but also on the final (overall) eradication rate. The choice of a 'rescue' treatment depends on which treatment is used initially. If a first-line clarithromycin-based regimen was used, a second-line metronidazole-based treatment (quadruple therapy) may be used afterwards, and then a levofloxacin-based combination would be a third-line 'rescue' option. Alternatively, it has recently been suggested that levofloxacin-based 'rescue' therapy constitutes an encouraging second-line strategy, representing an alternative to quadruple therapy in patients with previous PPI-clarithromycin-amoxicillin failure, with the advantage of efficacy, simplicity and safety. In this case, quadruple regimen may be reserved as a third-line 'rescue' option. Finally, rifabutin-based 'rescue' therapy constitutes an encouraging empirical fourth-line strategy after multiple previous eradication failures with key antibiotics such as amoxicillin, clarithromycin, metronidazole, tetracycline, and levofloxacin. Even after two consecutive failures, several studies have demonstrated that H. pylori eradication can finally be achieved in almost all patients if several 'rescue' therapies are consecutively given. Therefore, the attitude in H. pylori eradication therapy failure, even after two or more unsuccessful attempts, should be to fight and not to surrender.

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Helicobacter pylori first-line treatment and rescue option containing levofloxacin in patients allergic to penicillin

Cited by 53 publications

References 37 publications

Eradication of <i>H. pylori</i> Infection in Patients Allergic to Penicillin Using Triple Therapy with a PPI, Metronidazole and Sitafloxacin

Eradication of <i>H. pylori</i> Infection in Patients Allergic to Penicillin Using Triple Therapy with a PPI, Metronidazole and Sitafloxacin

Should quinolones come first in Helicobacter pylori therapy?

Review: Second-line rescue therapy of Helicobacter pylori infection

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