T he most widely used second-line therapy for Helicobacter pylori eradication is quadruple therapy, consisting of a proton pump inhibitor (PPI), a bismuth salt, metronidazole, and tetracycline, as recommended by the Maastricht 3-2005 and second Asian Pacific Consensus Report. [1,2] However, bismuth salts are not available worldwide anymore. Alternative second-line therapies with a good treatment report card are still in demand. Antibiotic resistance is one of the important factors in patients' non-responsiveness to initial treatment. [3] Usually, it is not suggested to repeat the same regimens when considering a second-line treatment for H. pylori.[4] Original ArticleBackground: 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. (Biomed J 2014;37:326-330)
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