Infection
Update

Quinolones News

#17 May 2, 2017

Sequential therapy with levofloxacin and metronidazole achieves greater than 90% eradication of Helicobacter pylori following failure of first-line therapy

Failure of first-line therapy for the eradication of Helicobacter pylori (H. pylori) necessitates effective second-line regimens, with levofloxacin recommended in such cases. Yet lengthy exposure to quinolone-containing therapy can lead to resistance. Sequential therapy has been recommended as a way to avoid this while also increasing compliance and reducing adverse events.

To investigate this, a group of Taiwanese researchers compared the efficacy of 5-plus 5 days’ levofloxacin and metronidazole-containing sequential therapy (EALM) to 10-day levofloxacin-containing triple therapy (EAL) in second-line H pylori eradication treatment.

164 patients who had failed H pylori eradication were randomized to sequential EALM (n = 82; esomeprazole 40 mg bid and amoxicillin 1 g bid for 5 days, followed by esomeprazole 40 mg bid, levofloxacin 500 mg qd, and metronidazole 500 mg tid, for 5 days) or 10-day EAL (n = 82; levofloxacin 500 mg qd, amoxicillin 1 g bid, and esomeprazole 40 mg bid).

Microbiological eradication rates for the sequential group were 90.2% and 91.4% in the ITT and PP analysis, respectively, compared to 80.5% and 81.5% for the 10-day EAL group. The adverse events for the EALM group were higher than the EAL groups (23.5% vs. 11.1%, P = 0.038) although almost all were mild, with compliance rates high at 98.8% and 100%, respectively.

The H pylori eradication rates for the levofloxacin-susceptible strains and levofloxacin-resistant strains were 100% (44/44) and 60.9% (14/23). All patients receiving sequential therapy with isolated levofloxacin resistance showed eradication, compared with only 50% in the EAL group (P = 0.039).

Thus researchers concluded that levofloxacin and metronidazole-containing sequential therapy achieved a >90% eradication rate as a second-line H pylori therapy, with dual resistance to levofloxacin and metronidazole the clinical factor influencing the efficacy of H pylori eradication therapy in sequential therapy.

PMID: 27175657

Medicine (Baltimore). 2016 May;95(19):e3586. doi: 10.1097/MD.0000000000003586.

Source: https://www.ncbi.nlm.nih.gov/pubme d/27175657?dopt=Abstract
 
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