Since the discovery of Helicobacter pylori (H. pylori) in 1982, a large amount of research has gone into developing successful eradication strategies. However this task has grown increasingly difficult, due primarily to greater antibiotic resistance, creating a challenging clinical issue in both developed and developing countries. To shed light on how best to manage patients after failure of first-line eradication therapy, researchers in Australia assessed the efficacy of salvage levofloxacin-based triple therapy.
In this prospective study, patients referred after prior treatment failure(s) were prescribed esomeprazole 40 mg, amoxicillin 1 g and levofloxacin 500 mg each twice daily for ten days. Evaluation of eradication was based on 13 C-urea breath test and/or histology and urease testing.
In 150 evaluable patients, main indications for treatment were peptic ulcer disease (17%), increased gastric cancer risk (20%), gastroenterological symptoms (35%) and other risk reduction (28%).
Results confirmed that the median number of failed prior therapies was 2 (range 1-7). Following treatment with the levofloxacin-containing salvage therapy, eradication of H. pylori was achieved in 90% and 91% of patients according to ITT and PP analysis, respectively. Researchers noted that the eradication rate did not change significantly when the number of prior treatment failures increased [(93% when ≤2 (n = 107), and 84% when 3 or more (n = 43; p = 0.13)] or with age, ethnicity, or reasons for starting treatment. However eradication rates were higher in females (ITT 94% v 82%, p = 0.04). Researchers found the levofloxacin-containing therapy to have a high compliance rate of 95%, due to excellent tolerability with no serious adverse effects and only mild adverse effects reported in 11%.
In conclusion, this levofloxacin-based triple therapy provides a useful salvage regimen in this region.
Intern Med J. 2017 Mar 27. doi: 10.1111/imj.13432.