Lansoprazole, levofloxacin and amoxicillin triple therapy vs. quadruple therapy as second‐line treatment of resistant Helicobacter pylori infection

• Published in: Alimentary pharmacology & therapeutics Vol. 23; no. 3; pp. 421 - 427
• Main Authors: WONG, W. M., GU, Q., CHU, K.‐M., YEE, Y. K., FUNG, F. M. Y., TONG, T. S. M., CHAN, A. O. O., LAI, K. C., CHAN, C. K., WONG, B. C. Y.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Science Ltd 01-02-2006; Blackwell
• Subjects: 2-Pyridinylmethylsulfinylbenzimidazoles; Adult; Aged; Amoxicillin - therapeutic use; Anti-Bacterial Agents - therapeutic use; Anti-Infective Agents - therapeutic use; Biological and medical sciences; Digestive system; Drug Resistance, Bacterial; Drug Therapy, Combination; Female; Gastroenterology. Liver. Pancreas. Abdomen; Helicobacter Infections - drug therapy; Helicobacter pylori; Hong Kong; Humans; Lansoprazole; Levofloxacin; Male; Medical sciences; Metronidazole - therapeutic use; Middle Aged; Ofloxacin - therapeutic use; Omeprazole - analogs & derivatives; Omeprazole - therapeutic use; Organometallic Compounds; Pharmacology. Drug treatments; Tetracycline - therapeutic use; Treatment Outcome; Hong Kong; Levofloxacin; H; Spirillaceae; K; Proton pump inhibitor; Penicillin derivatives; Fluoroquinolone derivatives; Helicobacter pylori; Antisecretory agent; Bacteria; Second line treatment; Quinolone derivatives; Spirillales; Enzyme; β-Lactams; Enzyme inhibitor; Infection; Resistance; Antibiotic; Benzimidazole derivatives; Amoxicillin; Bacteriosis; exchanging ATPase; Hydrolases; Antibacterial agent; Comparative study; Lansoprazole
• ISSN: 0269-2813; 1365-2036
• DOI: 10.1111/j.1365-2036.2006.02764.x

Summary
Aim
To test the efficacy of levofloxacin‐based second‐line therapy for resistant Helicobacter pylori infection.
Methods
One hundred and six patients who failed H. pylori eradication were randomized to receive (i) lansoprazole 30 mg, amoxicillin 1 g, levofloxacin 500 mg, all given twice daily for 7 days (LAL); or (ii) lansoprazole 30 mg twice daily, metronidazole 400 mg thrice daily, bismuth subcitrate 120 mg and tetracycline 500 mg four times daily for 7 days (quadruple). Post‐treatment H. pylori status was determined by 13C‐urea breath test.
Results
Intention‐to‐treat and per‐protocol H. pylori eradication rates were 57/60% for the LAL group and 71/76% for the quadruple group respectively. Metronidazole, clarithromycin, amoxicillin and levofloxacin resistance were found in 76%, 71%, 0% and 18% of patients, respectively. Levofloxacin resistance led to treatment failure in the LAL group. For patients with dual resistance to metronidazole and clarithromycin, the eradication rates were 79% in the LAL group (levofloxacin‐sensitive) and 65% in the quadruple group (P = 0.34).
Conclusion
Lansoprazole, amoxicillin plus levofloxacin second‐line therapy is comparable with quadruple therapy in efficacy. Subjects, especially those with dual resistance to metronidazole and clarithromycin, may consider levofloxacin‐based therapy for levofloxacin‐sensitive strains.