PMID- 23556551
OWN - NLM
STAT- MEDLINE
DCOM- 20140310
LR  - 20140731
IS  - 1502-7708 (Electronic)
IS  - 0036-5521 (Linking)
VI  - 48
IP  - 6
DP  - 2013 Jun
TI  - Second-line rescue triple therapy with levofloxacin after failure of non-bismuth 
      quadruple "sequential" or "concomitant" treatment to eradicate H. pylori 
      infection.
PG  - 652-6
LID - 10.3109/00365521.2013.786132 [doi]
AB  - BACKGROUND: Non-bismuth quadruple "sequential" and "concomitant" regimens, 
      including a proton pump inhibitor (PPI), amoxicillin, clarithromycin and a 
      nitroimidazole, are increasingly used as first-line treatments for Helicobacter 
      pylori infection. Eradication with rescue regimens may be challenging after 
      failure of key antibiotics such as clarithromycin and nitroimidazoles. AIM: To 
      evaluate the efficacy and tolerability of a second-line levofloxacin-containing 
      triple regimen (PPI-amoxicillin-levofloxacin) in the eradication of H. pylori 
      after non-bismuth quadruple-containing treatment failure. DESIGN: prospective 
      multicenter study. PATIENTS: in whom a non-bismuth quadruple regimen, 
      administered either sequentially (PPI + amoxicillin for 5 days followed by PPI + 
      clarithromycin + metronidazole for 5 more days) or concomitantly (PPI + 
      amoxicillin + clarithromycin + metronidazole for 10 days) had previously failed. 
      INTERVENTION: levofloxacin (500 mg b.i.d.), amoxicillin (1 g b.i.d.) and PPI 
      (standard dose b.i.d.) for 10 days. OUTCOME: eradication was confirmed with 
      (13)C-urea breath test 4-8 weeks after therapy. Compliance and tolerance: 
      compliance was determined through questioning and recovery of empty medication 
      envelopes. Incidence of adverse effects was evaluated by means of a 
      questionnaire. RESULTS: 100 consecutive patients were included (mean age 50 
      years, 62% females, 12% peptic ulcer and 88% dyspepsia): 37 after "sequential", 
      and 63 after "concomitant" treatment failure. All patients took all medications 
      correctly. Overall, per-protocol and intention-to-treat H. pylori eradication 
      rates were 75.5% (95% CI 66-85%) and 74% (65-83%). Respective intention-to-treat 
      cure rates for "sequential" and "concomitant" failure regimens were 74.4% and 
      71.4%, respectively. Adverse effects were reported in six (6%) patients; all of 
      them were mild. CONCLUSION: Ten-day levofloxacin-containing triple therapy 
      constitutes an encouraging second-line strategy in patients with previous 
      non-bismuth quadruple "sequential" or "concomitant" treatment failure.
FAU - Gisbert, Javier P
AU  - Gisbert JP
AD  - Gastroenterology Unit, Hospital Universitario de La Princesa and Instituto de 
      Investigacion Sanitaria Princesa (IP), Centro de Investigacion Biomedica en Red 
      de Enfermedades Hepaticas y Digestivas (CIBEREHD) , Madrid, Spain. 
      gisbert@meditex.es
FAU - Molina-Infante, Javier
AU  - Molina-Infante J
FAU - Marin, Alicia C
AU  - Marin AC
FAU - Vinagre, Gemma
AU  - Vinagre G
FAU - Barrio, Jesus
AU  - Barrio J
FAU - McNicholl, Adrian Gerald
AU  - McNicholl AG
LA  - eng
PT  - Clinical Trial
PT  - Journal Article
PT  - Multicenter Study
PT  - Research Support, Non-U.S. Gov't
DEP - 20130405
PL  - England
TA  - Scand J Gastroenterol
JT  - Scandinavian journal of gastroenterology
JID - 0060105
RN  - 0 (Anti-Bacterial Agents)
RN  - 0 (Proton Pump Inhibitors)
RN  - 140QMO216E (Metronidazole)
RN  - 6GNT3Y5LMF (Levofloxacin)
RN  - 804826J2HU (Amoxicillin)
RN  - H1250JIK0A (Clarithromycin)
SB  - IM
MH  - Amoxicillin/therapeutic use
MH  - Anti-Bacterial Agents/adverse effects/*therapeutic use
MH  - Clarithromycin/therapeutic use
MH  - Drug Therapy, Combination/adverse effects
MH  - Female
MH  - Helicobacter Infections/*drug therapy
MH  - *Helicobacter pylori
MH  - Humans
MH  - Levofloxacin/adverse effects/*therapeutic use
MH  - Male
MH  - Metronidazole/therapeutic use
MH  - Middle Aged
MH  - Proton Pump Inhibitors/therapeutic use
MH  - Treatment Failure
EDAT- 2013/04/06 06:00
MHDA- 2014/03/13 06:00
CRDT- 2013/04/06 06:00
PHST- 2013/04/06 06:00 [entrez]
PHST- 2013/04/06 06:00 [pubmed]
PHST- 2014/03/13 06:00 [medline]
AID - 10.3109/00365521.2013.786132 [doi]
PST - ppublish
SO  - Scand J Gastroenterol. 2013 Jun;48(6):652-6. doi: 10.3109/00365521.2013.786132. 
      Epub 2013 Apr 5.