These authors contributed equally to this study.
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Lansoprazole, levofloxacin and amoxicillin triple therapy vs. quadruple therapy as second-line treatment of resistant Helicobacter pylori infection
Article first published online: 16 JAN 2006
DOI: 10.1111/j.1365-2036.2006.02764.x
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How to Cite
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. and WONG, B. C. Y. (2006), Lansoprazole, levofloxacin and amoxicillin triple therapy vs. quadruple therapy as second-line treatment of resistant Helicobacter pylori infection. Alimentary Pharmacology & Therapeutics, 23: 421–427. doi: 10.1111/j.1365-2036.2006.02764.x
Publication History
- Issue published online: 16 JAN 2006
- Article first published online: 16 JAN 2006
- Publication data Submitted 24 October 2005 First decision 1 November 2005 Resubmitted 7 November 2005 Accepted 14 November 2005
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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.