• Javier P Gisbert, Angeles Pérez-Aisa, Fernando Bermejo, Manuel Castro-Fernández, Pedro Almela, Jesús Barrio, Angel Cosme, Inés Modolell, Felipe Bory, Miguel Fernández-Bermejo, Luis Rodrigo, Jesús Ortuño, Pilar Sánchez-Pobre, Sam Khorrami, Alejandro Franco, Albert Tomas, Iván Guerra, Eloisa Lamas, Julio Ponce, Xavier Calvet, and H. pylori Study Group of the Asociación Española de Gastroenterología (Spanish Gastroenterology Association).
• Gastroenterology Unit, La Princesa, Instituto de Investigación Sanitaria Princesa (IP) y, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain. gisbert@meditex.es
• J. Clin. Gastroenterol. 2013 Feb 1; 47 (2): 130-5.

BackgroundSecond-line bismuth-containing quadruple therapy is complex and frequently induces adverse effects. A triple rescue regimen containing levofloxacin is a potential alternative; however, resistance to quinolones is rapidly increasing.AimTo evaluate the efficacy and tolerability of a second-line triple-regimen-containing levofloxacin in patients whose Helicobacter pylori eradication treatment failed and to assess whether the efficacy of the regimen decreases with time.MethodsDesignProspective multicenter study.PatientsIn whom treatment with a regimen comprising a proton-pump inhibitor, clarithromycin, and amoxicillin had failed.InterventionLevofloxacin (500 mg bid), amoxicillin (1 g bid), and omeprazole (20 mg bid) for 10 days.OutcomeEradication was confirmed using the C-urea breath test 4 to 8 weeks after therapy. Compliance/tolerance: Compliance was determined through questioning and recovery of empty medication envelopes. Incidence of adverse effects was evaluated by means of a questionnaire.ResultsThe study sample comprised 1000 consecutive patients (mean age, 49 ± 15 y, 42% men, 33% peptic ulcer) of whom 97% took all medications correctly. Per-protocol and intention-to-treat eradication rates were 75.1% (95% confidence interval, 72%-78%) and 73.8% (95% confidence interval, 71%-77%). Efficacy (intention-to-treat) was 76% in the year 2006, 68% in 2007, 70% in 2008, 76% in 2009, 74% in 2010, and 81% in 2011. In the multivariate analysis, none of the studied variables (including diagnosis and year of treatment) were associated with success of eradication. Adverse effects were reported in 20% of patients, most commonly nausea (7.9%), metallic taste (3.9%), myalgia (3.1%), and abdominal pain (2.9%).ConclusionsTen-day levofloxacin-containing therapy is an encouraging second-line strategy, providing a safe and simple alternative to quadruple therapy in patients whose previous standard triple therapy has failed. The efficacy of this regimen remains stable with time.

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