Third-Line Rescue Therapy with Levofloxacin After Two H. pylori Treatment Failures

Gisbert, Javier P.; Castro‐Fernández, Manuel; Bermejo, Fernando; Pérez-Aísa, Ángeles; Ducóns, Julio; Fernandez–Bermejo, Miguel; Bory, Felipe; Cosme, Ángel; Benito, Luis-Miguel; López-Rivas, Laureano; Lamas, Eloisa; Pabón, Manuel; Olivares, David

doi:10.1111/j.1572-0241.2006.00457.x

Cited by 96 publications

(53 citation statements)

References 23 publications

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“…On the other hand, empirical treatment after two failed attempts has shown heterogeneous results: 65-85% with bismuth-containing quadruple therapies [Hsu et al 2008;Gisbert et al 2014], 60-90% with levofloxacin-based therapy [Sereni et al 2012;Tursi et al 2012;Gisbert et al 2006;Zullo et al 2003a] and 62-95% with a rifabutinbased therapy associated with PPIs and amoxicillin [Lim et al 2014;González et al 2007]. The studies differ in terms of previously administered therapies, study populations and drug schedules.…”

Section: Discussionmentioning

confidence: 99%

Systematic review: third-line susceptibility-guided treatment for Helicobacter pylori infection

Puig

López-Góngora

Calvet

et al. 2016

Therap Adv Gastroenterol

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Background: Susceptibility-guided therapies (SGTs) have been proposed as preferable to empirical rescue treatments after two treatment failures. The aim of this study was to perform a systematic review and meta-analysis evaluating the effectiveness and efficacy of SGT as third-line therapy. Methods: A systematic search was performed in multiple databases. Studies reporting cure rates of Helicobacter pylori with SGT in third-line therapy were selected. A qualitative analysis describing the current evidence and a pooled mean analysis summarizing the cure rates of SGT in third-line therapy was performed. Results: No randomized controlled trials or comparative studies were found. Four observational studies reported cure rates with SGT in third-line treatment, and three studies which mixed patients with second-and third-line treatment also reported cure rates with SGT. The majority of the studies included the patients when culture had been already obtained, and so the effectiveness of SGT and empirical therapy has never been compared. A pooled mean analysis including four observational studies (283 patients) showed intention-to-treat and perprotocol eradication rates with SGT of 72% (95% confidence interval 56-87%; I 2 : 92%) and 80% (95% confidence interval 71-90%; I 2 : 80%), respectively. Conclusions: SGT may be an acceptable option as rescue treatment. However, cure rates are, at best, moderate and this approach has never been compared with a well-devised empirical therapy. The evidence in favor of SGT as rescue therapy is currently insufficient to recommend its use.

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Section: Discussionmentioning

confidence: 99%

Systematic review: third-line susceptibility-guided treatment for Helicobacter pylori infection

Puig

López-Góngora

Calvet

et al. 2016

Therap Adv Gastroenterol

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“…Levofloxacin-based 'rescue' regimens It has been suggested that levofloxacin-based therapies may also represent an alternative when two (or more) consecutive eradication treatments have failed to eradicate the infection [Nishizawa et al 2009;Hsu et al 2008;Rokkas et al 2006;Gisbert et al 2006aGisbert et al , 2006bGisbert et al , 2005aCoelho et al 2005;Gatta et al 2005;Bilardi et al 2004;Zullo et al 2003aZullo et al , 2001a. As an example, a recent study by Zullo et al [2003a] aimed to evaluate the efficacy of a levofloxacin-amoxicillin-PPI combination in patients who previously had failed two or more therapeutic attempts, and eradication rate was 83% (intention-to-treat analysis).…”

Section: Amoxicillin±tetracycline-based Regimensmentioning

confidence: 99%

“…Therefore, the position in the case of therapy failure would be clear: do not readminister any of the antibiotics against which H. pylori has probably become resistant [Howden and Hunt, 1998;Lam and Talley, 1998]. (9) Finally, relatively high eradication rates have been obtained with empirical third-line treatment after two consecutive failures in several studies [Gisbert et al 2008b[Gisbert et al , 2006a[Gisbert et al , 2006b[Gisbert et al , 2004[Gisbert et al , 2003 However, limited experience suggests that endoscopy with culture and susceptibility testing may be appropriate after failure of two eradication therapies; in this situation, a nonrandomized retrospective study suggests that third-line therapy directed by the results of sensitivity testing improve eradication compared to further empirical antibiotics, demonstrating that the success rate of sensitivity-directed therapy is superior to PPI-amoxicillin-rifabutin triple therapy, and therefore suggesting that endoscopy and sensitivity testing at this point may be worthwhile rather than more widespread use of rifabutin-based regimens [Beales, 2001]. Cammarota et al…”

Section: Introductionmentioning

confidence: 99%

Review: Second-line rescue therapy of Helicobacter pylori infection

Gisbert

2009

Therap Adv Gastroenterol

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Helicobacter pylori infection is the main known cause of gastritis, gastroduodenal ulcer disease and gastric cancer. After more than 20 years of experience in H. pylori treatment, however, the ideal regimen to treat this infection has still to be found. Nowadays, apart from having to know well first-line eradication regimens, we must also be prepared to face treatment failures. Therefore, in designing a treatment strategy we should not focus on the results of primary therapy alone, but also on the final (overall) eradication rate. The choice of a 'rescue' treatment depends on which treatment is used initially. If a first-line clarithromycin-based regimen was used, a second-line metronidazole-based treatment (quadruple therapy) may be used afterwards, and then a levofloxacin-based combination would be a third-line 'rescue' option. Alternatively, it has recently been suggested that levofloxacin-based 'rescue' therapy constitutes an encouraging second-line strategy, representing an alternative to quadruple therapy in patients with previous PPI-clarithromycin-amoxicillin failure, with the advantage of efficacy, simplicity and safety. In this case, quadruple regimen may be reserved as a third-line 'rescue' option. Finally, rifabutin-based 'rescue' therapy constitutes an encouraging empirical fourth-line strategy after multiple previous eradication failures with key antibiotics such as amoxicillin, clarithromycin, metronidazole, tetracycline, and levofloxacin. Even after two consecutive failures, several studies have demonstrated that H. pylori eradication can finally be achieved in almost all patients if several 'rescue' therapies are consecutively given. Therefore, the attitude in H. pylori eradication therapy failure, even after two or more unsuccessful attempts, should be to fight and not to surrender.

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“…1 Similarly, some years ago we obtained encouraging results with a third-line combination of PPI-amoxicillinlevofloxacin in a Spanish pilot study. 5 We have just ) seem encouraging, especially when it is taken into account that our rescue regimen was prescribed empirically after two eradication failures. Furthermore, this regimen was well-tolerated, with adverse effects reported in 19% of the patients, and most were mild to moderate in severity and transient: myalgia (8%), nausea (6%), metallic taste (5%), abdominal pain (3%), and diarrhoea (3%).…”

mentioning

confidence: 84%

“…[5][6][7][8][9][10] Mean eradication rate calculated from these six studies was 73%. However, the sample size of the individual studies was low, with only 350 in total when all studies were considered.…”

mentioning

confidence: 97%

Letter: third‐line rescue therapy with levofloxacin after failure of two treatments to eradicate Helicobacter pylori infection

Gisbert

2012

Aliment Pharmacol Ther

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Third-Line Rescue Therapy with Levofloxacin After Two H. pylori Treatment Failures

Abstract: Levofloxacin-based rescue therapy constitutes an encouraging empirical third-line strategy after multiple previous H. pylori eradication failures with key antibiotics such as amoxicillin, clarithromycin, metronidazole, and tetracycline.

Cited by 96 publications

References 23 publications

Systematic review: third-line susceptibility-guided treatment for Helicobacter pylori infection

Systematic review: third-line susceptibility-guided treatment for Helicobacter pylori infection

Review: Second-line rescue therapy of Helicobacter pylori infection

Letter: third‐line rescue therapy with levofloxacin after failure of two treatments to eradicate Helicobacter pylori infection

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