Levofloxacin-containing second-line anti-Helicobacter pylori eradication in Taiwanese real-world practice

Biomed J. Sep-Oct 2014;37(5):326-30. doi: 10.4103/2319-4170.125650.

Abstract

Background: Quinolone-containing triple therapy is recommended as an option for non-bismuth containing second-line Helicobacter pylori eradication. Current available Taiwanese reports in the literature used 7-day quinolone-containing triple therapy. As a result, some physicians still prescribe 7-day regimens in real-world practice in Taiwan. This study aimed to further assess the appropriateness of 7-day levofloxacin-containing triple therapy as second-line therapy.

Methods: We enrolled 61 patients who failed H. pylori eradication using the standard triple therapy for 7 days and were prescribed levofloxacin-containing second-line triple therapy (levofloxacin 500 mg once daily, amoxicillin 1 g twice daily, and esomeprazole 40 mg twice daily). Routine follow-up with either endoscopy or urea breath test was done 8 weeks later to assess treatment response.

Results: The eradication rates were 78.7% in the intention-to-treat analysis and 81% in the per-protocol analysis. The incidence of adverse events was 6.6%. Drug compliance was 95.1%. Antibiotic resistance showed the following results: Amoxicillin (0%), levofloxacin (23.5%), clarythromycin (35.3%), metronidazole (17.6%), and tetracycline (0%).

Conclusion: The 7-day levofloxacin-containing triple therapy provides an unacceptable per-protocol report card as the second-line treatment for anti-H. pylori eradication in Taiwan and should be modified by either extending the duration to 10-14 days or seeking other regimens.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Amoxicillin / pharmacology*
  • Anti-Bacterial Agents / therapeutic use*
  • Asian Continental Ancestry Group
  • Clarithromycin / therapeutic use
  • Drug Administration Schedule
  • Drug Therapy, Combination / methods
  • Esomeprazole / therapeutic use
  • Female
  • Helicobacter Infections / drug therapy*
  • Helicobacter pylori / drug effects*
  • Humans
  • Levofloxacin / therapeutic use*
  • Male
  • Metronidazole / therapeutic use
  • Middle Aged
  • Taiwan
  • Treatment Outcome

Substances

  • Anti-Bacterial Agents
  • Metronidazole
  • Levofloxacin
  • Amoxicillin
  • Clarithromycin
  • Esomeprazole