Quinolones News

#8 May 2, 2017

Levofloxacin-based, third-line therapy effective for eradicating Helicobacter pylori in peptic ulcer disease (PUD)

Eradication of Helicobacter pylori (H. pylori) is known to be associated with a dramatic reduction in PUD, but effective antimicrobial therapy is hindered by increasing resistance, particularly to clarithromycin. In Korea, which has a high prevalence of H. pylori, standard first-line triple therapy has decreased eradication (80%) and failure rates for second-line therapy have reached 15-20%. At present there are no recommended third-line regimens in the Korean guidelines, so this study aimed at evaluating the efficacy of levofloxacin-based third-line H. pylori eradication in PUD. Levofloxacin has broad activity against both Gram-positive and negative pathogens with a recent Korean study reporting near 80% efficacy for levofloxacin-based sequential therapy as first-line treatment.

This retrospective multicenter study enrolled 110 patients between 2002 and 2014, who had received levofloxacin-based third-line H. pylori eradication therapy for PUD, with 88 included in the study. Failure of first and second line therapies was confirmed by either C-urea breath test, rapid urease test or biopsy before therapy. Eradication rates, treatment regimens and durations, and types of peptic ulcers were analyzed.

Males comprised 60.2% of participants, and the median age was 57. The duration of treatment ranged from 7-14 days and the overall eradication rate was 71.6% with no statistical difference in eradication rates based on treatment duration (7-days, 80.6% vs 10-days, 64.0% vs 14-days, 68.8%, p=0.353) or type of ulcer (gastric ulcer, 73.2% vs duodenal/gastroduodenal ulcer, 68.8%, p=0.655). The adherence rate was 80.0%.

The researchers concluded that these results using a PPI, amoxicillin and levofloxacin as third-line therapy were promising, since patients had failed two previous regimens, even without a susceptibility test.

PMID: 27609487

Gut Liver. 2017 Mar 15;11(2):226-231. doi: 10.5009/gnl16099.

Source: https://www.ncbi.nlm.nih. gov/pubmed/27609487?dopt=Abstract

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