Alimentary TractLevofloxacin-based triple therapy for Helicobacter pylori re-treatment: Role of bacterial resistance
Introduction
Standard triple therapies fail to cure Helicobacter pylori infection in more than 20–30% of patients [1], [2]. In the last five years, several studies have found an eradication rate lower than 75% [3], [4], [5], [6], and values as low as 25–45% have been also recently reported [7], [8]. A quadruple therapy with proton pump inhibitor, bismuth salt, tetracycline and metronidazole is currently advised as second-line therapy in eradication failure patients [9], [10], [11]. However, data regarding the eradication rate achieved following such a therapy regimen are controversial, with values widely ranging from 37 to 91% [12], [13]. Moreover, bismuth salts (as well as ranitidine bismuth citrate) are not anymore available worldwide. Therefore, management of first-line eradication failure patients is become challenging.
A levofloxacin–amoxycillin-based triple therapy has been proved to be acceptably effective as second- or even third-line therapy [14], [15], [16], [17], and two recent meta-analyses showed a higher eradication rate as compared to standard quadruple therapy as a re-treatment [18], [19]. It has been found that a 10-day levofloxacin-based regimen achieve higher cure rate than the 7-day regimen, whilst levofloxacin dose (250 mg b.d versus 500 o.d.) seem to be equally effective [18], [19]. Bacterial resistance to antibiotics is widely claimed as the most important factor reducing the efficacy of standard triple therapy [20]. However, only scanty data are currently available on the role of primary levofloxacin resistance on levofloxacin-based triple therapy efficacy [16], [17], [21].
The present study aimed to assess the efficacy of a levofloxacin–amoxycillin triple therapy as a second-line treatment, and the role of primary levofloxacin resistance.
Section snippets
Patients
This was a prospective, open-label study performed in two centres (Bologna and Rome). All patients enrolled in previous trial [22] and with persistent H. pylori infection following a first-line therapy were invited to participate in this study. There were 40 patients who failed either a 10-day triple therapy (pantoprazole 40 mg b.d., clarithromycin 500 mg b.d., and amoxycillin 1 g b.d.) (N = 30) or a 10-day sequential regimen (pantoprazole 40 mg b.d. plus amoxycillin 1 g for the first 5 days, followed
Results
Forty patients (Bologna: 25 patients; Rome: 15 patients) with persistent H. pylori infection after a first-line therapy were identified. Overall, bacterial culture was successful achieved in 33 (82.5%) cases, and 10 (30.3%) of these patients were infected with a levofloxacin resistant strain. The prevalence of primary levofloxacin resistance did not differ between the two participating centres (7/22, 31.8% versus 3/11, 27.3%, P = 0.3), nor between patients who previously failed standard or
Discussion
Recent data suggest that the success rate of standard 7–14 days triple therapies is decreasing worldwide [1], [2], [3], [4], [5], [6], [7], [8]. Moreover, it is known that bacterial eradication following a failed initial therapy is notoriously difficult to achieve. Current US, Canadian, and European guidelines suggest the use of a quadruple therapy as a second-line therapy [9], [10], [11], but bismuth salts are not any more available worldwide. Therefore, H. pylori management in the clinical
Conflict of interest statement
None declared.
Acknowledgement
No external funding was received for this study.
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