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H. Pylori/Ulcer
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my personal edition > h. pylori/ulcer > news
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DGReview
Levofloxacin May Be Effective Option in Second Line Treatment of Helicobacter pylori Infection
A DGReview of :"Levofloxacin based triple therapy as a second-line treatment after failure of helicobacter pylori eradication with standard triple therapy"
Digestive and Liver Disease
12/05/2003
By Deanna M Green, PhD
Levofloxacin-based triple therapy appears to be a safe and effective second-line treatment for the eradication of Helicobacter pylori after failure of standard lansoprazole-amoxicillin-clarithromycin therapy, according to a preliminary Japanese study.
Standard first-line treatments for the eradication of H. pylori infection tend to fail in about 20% of patients. Choosing the best therapeutic option for successful eradication after initial treatment failure can be difficult.
Levofloxacin is a fluoroquinolone that has shown in vitro activity against both Gram-negative and Gram-positive microorganisms. The use of levofloxacin in first line therapy has been studied; however, its potential as a second-line option has not been investigated.
Researchers at the Kobe University School of Medicine, Kobe, Japan, evaluated the efficacy and tolerability of a levofloxacin-based triple therapy as a second-line approach to eradication of H. pylori.
The prospective, uncontrolled study included 33 patients in whom standard triple therapy (lansoprazole-amoxicillin-clarithromycin) failed to eradicate H. pylori infection after 1 week of treatment. Patients were retreated with lansoprazole (30 mg twice daily), amoxicillin (1000 mg twice daily), and levofloxacin (200 mg twice daily) for 1 week.
The infection was considered to be cured if negative results were obtained from culture, histology and a urea breath test 4 to 8 weeks after second-line therapy.
Overall, 69.7% of patients achieved successful eradication of H. pylori 4 to 8 weeks after levofloxacin-based treatment. Notably, a similar eradication rate was seen in both intent-to-treat and per-protocol analyses.
Mild side effects were reported by 7 patients, or 21.2%. These reports included soft stools and taste disturbance. Importantly, no patients discontinued treatment due to adverse events.
These findings suggest the efficacy levofloxacin-based triple therapy as a second-line treatment for eradication of H. pylori infection after failure of standard first-line therapy.
Dig Liver Dis 2003 Oct;35:10:711-5.
"Levofloxacin based triple therapy as a second-line treatment after failure of helicobacter pylori eradication with standard triple therapy"
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