%0 Journal Article
%A Gisbert, J. P.
%A Romano, M.
%A Gravina, A. G.
%A Solis-Munoz, P.
%A Bermejo, F.
%A Molina-Infante, J.
%A Castro-Fernandez, M.
%A Ortuno, J.
%A Lucendo, A. J.
%A Herranz, M.
%A Modolell, I.
%A del Castillo, F.
%A Gomez, J.
%A Barrio, J.
%A Velayos, B.
%A Gomez, B.
%A Dominguez, J. L.
%A Miranda, A.
%A Martorano, M.
%A Algaba, A.
%A Pabon-Carrasco, Manuel
%A Angueira, T.
%A Fernandez-Salazar, L.
%A Federico, A.
%A Marin, A. C.
%A McNicholl, A. G.
%T Helicobacter pylori second-line rescue therapy with levofloxacin- and bismuth-containing quadruple therapy, after failure of standard triple or non-bismuth quadruple treatments
%D 2015
%@ 0269-2813
%U https://hdl.handle.net/10668/28461
%X Background: The most commonly used second-line Helicobacter pylori eradication regimens are bismuth-containing quadruple therapy and levofloxacin-containing triple therapy, both offering suboptimal results. Combining bismuth and levofloxacin may enhance the efficacy of rescue eradication regimens.Aims: To evaluate the efficacy and tolerability of a second-line quadruple regimen containing levofloxacin and bismuth in patients whose previous H. pylori eradication treatment failed.Methods: This was a prospective multicenter study including patients in whom a standard triple therapy (PPI-clarithromycin-amoxicillin) or a non-bismuth quadruple therapy (PPI-clarithromycin-amoxicillin-metronidazole, either sequential or concomitant) had failed. Esomeprazole (40mg b.d.), amoxicillin (1g b.d.), levofloxacin (500mg o.d.) and bismuth (240mg b.d.) was prescribed for 14days. Eradication was confirmed by C-13-urea breath test. Compliance was determined through questioning and recovery of empty medication envelopes. Incidence of adverse effects was evaluated by questionnaires.Results: 200 patients were included consecutively (mean age 47years, 67% women, 13% ulcer). Previous failed therapy included: standard clarithromycin triple therapy (131 patients), sequential (32) and concomitant (37). A total of 96% took all medications correctly. Per-protocol and intention-to-treat eradication rates were 91.1% (95%CI=87-95%) and 90% (95%CI=86-94%). Cure rates were similar regardless of previous (failed) treatment or country of origin. Adverse effects were reported in 46% of patients, most commonly nausea (17%) and diarrhoea (16%); 3% were intense but none was serious.Conclusions: Fourteen-day bismuth- and levofloxacin-containing quadruple therapy is an effective (90% cure rate), simple and safe second-line strategy in patients whose previous standard triple or non-bismuth quadruple (sequential or concomitant) therapies have failed.
%K Concomitant therapy
%K Sequential therapy
%K Eradication
%K Infection
%K Resistence
%K Efficacy
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