The Efficacy of Levofloxacin-based Triple Therapy for Helicobacter Pylori Eradication after Failure with Clarithromycin-Containing Regimens

Abstract

Background:
Clinical trials and meta-analyses have reported about 20% failure rates in first-line Helicobacter pylori (H. pylori) eradication. This reflects the need for effective second-line eradication regimens.

Materials and Methods:
61 patients with H. pylori infection who had failed previous non-bismuth clarithromycin-containing first line therapies entered the study. They were given a 14-day levofloxacin-containing triple regimen consisted of pantoprazole 40 mg, amoxicillin 1gr, and levofloxacin 500mg, each given twice daily. Eight weeks after the treatment, H. pylori eradication was assessed by 14C-urea breath test.

Results:
All patients completed the study. The eradication rate was 91.8% (95% confidence interval = 84.9% – 98.6%) by both intention to treat and per-protocol analyses. Side effects of therapy were reported by eight patients (13.1%), but they were severe in only two patients (3.2%).

Conclusion:
According to the high H. pylori eradication rate and the very low rate of severe adverse effects, levofloxacin-containing triple therapy seems to be a suitable second-line option in case of previous failure by clarithromycin-containing therapies. We suggest further studies with shorter duration of treatment or lower dose of levofloxacin.