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Ann Gastroenterol. 2014;27(4):357-361.

First- and second-line Helicobacter pylori eradication with modified sequential therapy and modified levofloxacin-amoxicillin-based triple therapy.

Author information

1
Gastroenterology and Digestive Endoscopy, "Nuovo Regina Margherita" Hospital Rome (Angelo Zullo, Cesare Hassan), Italy.
2
Gastroenterology Unit, Sapienza University of Rome, "Polo Pontino" Hospital, Latina (Lorenzo Ridola, Domenico Alvaro), Italy.
3
Gastroenterology and Digestive Endoscopy, Israelitic Hospital, Rome (Cesare Efrati, Giorgia Nikolini, Claudio Cannaviello), Italy.
4
Endoscopy Unit, Ruiniti Hospital, Foggia (Floriana Giorgio, Vincenzo De Francesco), Italy.
5
Gastroenterology and Digestive Endoscopy; "Versilia" Hospital, Lido di Camaiore (Luigi Gatta), Italy.

Abstract

BACKGROUND:

Helicobacter pylori (H. pylori) treatment remains a challenge for physicians. Although highly effective, the standard sequential therapy fails in a certain number of patients. Moreover, the cure rate following a levofloxacin-amoxicillin second-line triple therapy seems to be decreasing. We tested the efficacy of modified 10-day sequential therapy, and an intensified levofloxacin-amoxicillin regimen as first- and second-line therapy respectively.

METHODS:

In this prospective, open label, multicenter, pilot study H. pylori-infected patients received a first-line modified 10-day sequential therapy regimen including rabeprazole 20 mg, and amoxicillin 1 g for the first 3 days, followed by rabeprazole 20 mg, clarithromycin 250 mg, and metronidazole 250 mg, for the remaining 7 days, all drugs given thrice daily. An 8-day therapy regimen with rabeprazole 20 mg, levofloxacin 250 mg, and amoxicillin 1 g, all thrice daily, was administered a second-line therapy.

RESULTS:

A total of 99 and 15 patients were enrolled for first- and second-line therapy. The eradication rates were 85.9% (95% CI 80-93) and 93.4% (95% CI 88-98) according to ITT and PP analyses following modified sequential therapy, and 60% (95% CI 35-86) and 64.3% (95% CI 39-89) following the intensified second-line therapy.

CONCLUSION:

A modified sequential 3- plus 7-day regimen with thrice daily drug administration failed to achieve very high eradication rate at ITT analysis. The intensified second-line regimen achieved disappointingly low eradication rate. Novel levofloxacin-free second-line therapies are urged in Italy.

KEYWORDS:

Helicobacter pylori; modified levofloxacin triple therapy; modified sequential therapy; second-line therapy; sequential therapy; therapy

PMID:
25330819
PMCID:
PMC4188933

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