Su1681 Second-Line Rescue Therapy With Levofloxacin After Failure of Treatment to Eradicate Helicobacter pylori Infection: Time Trends in a Spanish Multicenter Study of 1,000 Patients

Two-week, high-dose proton pump inhibitor, moxifloxacin triple Helicobacter pylori therapy after failure of standard triple or non-bismuth quadruple treatments

“…The increase of moxifloxacin resistance reported in several studies [18,46] could be explained by cross-resistance across other fluoroquinolones like ciprofloxacin and levofloxacin [48]. However, in our previous Spanish study [13], the efficacy of the levofloxacincontaining regimen remained constant over time from the year 2006 to 2011; this constant eradication rate may reflect, perhaps, that in our country the quinolone resistance rate has not increased as fast as it has been described for clarithromycin resistance [4].…”

“…We previously obtained "intermediate" results (74% eradication rate) with a combination of a PPI, amoxicillin, and levofloxacin given for 10 days in multicenter studies performed in Spain [13,14]. On the other hand, recent studies suggest that the efficacy of levofloxacin-containing therapy is decreasing, most likely due to increased primary quinolone resistance [15].…”

III Conferencia Española de Consenso sobre la infección por Helicobacter pylori

“…Estos alentadores resultados con levofloxacino han sido confirmados recientemente en un amplio estudio multicéntrico español, en el que 1.000 pacientes en los que había fracasado un primer tratamiento erradicador con IBP-claritromicina-amoxicilina recibieron durante 10 días levofloxacino (500 mg/12 h), amoxicilina (1 g/12 h) y omeprazol (20 mg/12 h) 256 . La erradicación se logró en el 74% de los pacientes y, aunque se describieron efectos adversos en una quinta parte de los casos, ninguno de ellos fue grave.…”

“…En este estudio se valoró también si la eficacia disminuía con el paso del tiempo, pues las resistencias a las quinolonas en España parecen estar incrementándose con rapidez. Sin embargo, las tasas de erradicación fueron del 76% en el año 2006, del 68% en 2007, del 70% en 2008, del 76% en 2009, del 74% en 2010 y del 81% en 2011, por lo que se concluye que, al menos de momento, la eficacia de este tratamiento se mantiene estable con el paso del tiempo 256 .…”

Practical Aspects in Choosing a Helicobacter pylori Therapy

“…60 Indeed, 7-day triple therapy, including PPI, amoxicillin, and levofloxacin, provides cure rates of typically less than 80%; extending the duration to 10 days improves outcomes, but the treatment success has remained typically less than 90%. [60][61][62][63] Treatment success would decrease to less than 90% with 14-day Table 4 Current rescue therapeutic recommendations, in the era of increasing fluoroquinolone resistance, in patients with high risk of acquired clarithromycin and/or metronidazole resistance after failure of first eradication regimen fluoroquinolone triple therapy when fluoroquinolone resistance rates exceed approximately 12%, 64 whereas 14-day bismuth-containing fluoroquinolone quadruple therapy will not reach 90% cure rates in areas with a fluoroquinolone resistance of up to approximately 25%. 65 Therefore, awareness of local resistance rates or close monitoring of cure rates are mandatory in order to promptly detect inefficacy of these therapies.…”