Levofloxacin-based triple therapy for Helicobacter pylori re-treatment: Role of bacterial resistance

Perna, Francesco; Zullo, Angelo; Ricci, Chiara; Hassan, Cesare; Morini, Sergio; Vaira, Dino

doi:10.1016/j.dld.2007.06.016

Cited by 92 publications

(68 citation statements)

References 38 publications

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“…Levofloxacin is known to have a low MIC for H. pylori and is often used in rescue regimens. However, the eradication rate of levofloxacin-based regimens in patients infected with levofloxacin-resistant strains of H. pylori is low (12). The incidence of levofloxacin-resistant strains of H. pylori is high in Japan (13).…”

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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“…Resistance to quinolones is easily acquired and broad consumption of quinolones will increase the resistance rates (20,37,38). Perna et al (39) showed that in the presence of levofloxacin resistance, the efficacy and also the eradication rate of levofloxacin-based regimens were decreasing. In light of these data, it was proposed that these drugs should be used as initial therapy only in areas where primary resistance is low (e.g.…”

Section: Discussionmentioning

confidence: 99%

Comparison of 7- and 14-day first-line therapies including levofloxacin in patients with Helicobacter pylori positive non-ulcer dyspepsia

Erçin¹,

Uygun²,

Toros³

et al. 2010

Turk J Gastroenterol

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Helicobacter pylori (Hp) infection causes gastritis and gastroduodenal ulcer disease and is also associated with mucosa-associated lymphoid tissue (MALT) lymphoma and gastric cancer. In more than 20 years, researchers dealing with the eradication of this pathogen have been unable to find the ideal protocol, because the generally accepted minimum success rate of treatment regimens for Hp eradication is 80% (1, 2).The current standard first-line treatment to eradicate Hp is triple therapy, combining a proton pump inhibitor (PPI) with two antibiotics, mainly clarithromycin (500 mg b.i.d.) and amoxicillin (1 g b.i.d.) or metronidazole (500 mg b.i.d.), according Turk J Gastroenterol 2010; 21 (1): 12-16

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“…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] .…”

Section: Rbc Tetracycline and Metronidazolementioning

confidence: 99%

“Rescue” regimens after Helicobacter pylori treatment failure

Gisbert¹

2008

WJG

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Helicobacter pylori (H pylori ) infection is the main cause of gastritis, gastroduodenal ulcer disease, and gastric cancer. After more than 20 years of experience in H pylori treatment, in my opinion, the ideal regimen to treat this infection is still to be found. Currently, apart from having to know first-line eradication regimens well, 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 clarithromycinbased regimen was used initially, a subsequent metronidazole-based treatment (quadruple therapy) may be used afterwards, and then a levofloxacinbased combination would be a third "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, a quadruple regimen may be reserved as a third-line rescue option. Finally, rifabutin-based rescue therapy constitutes an encouraging empirical fourthline 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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Levofloxacin-based triple therapy for Helicobacter pylori re-treatment: Role of bacterial resistance

Cited by 92 publications

References 38 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

Comparison of 7- and 14-day first-line therapies including levofloxacin in patients with Helicobacter pylori positive non-ulcer dyspepsia

“Rescue” regimens after Helicobacter pylori treatment failure

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