Efficacy of H. pylori eradication with a sequential regimen followed by rescue therapy in clinical practice

Dig Liver Dis. 2010 Aug;42(8):541-3. doi: 10.1016/j.dld.2009.12.007. Epub 2010 Jan 12.

Abstract

Background: Current Italian guidelines suggest sequential therapy as first-line therapy and a levofloxacin-based rescue therapy for Helicobacter pylori eradication. We evaluated the efficacy of these therapies in clinical practice.

Methods: 84 consecutive patients with dyspeptic symptoms and proven H. pylori infection by either UBT or upper endoscopy with biopsies were enrolled. Patients received a 10-day sequential therapy with lansoprazole 30mg plus amoxycillin 1g (all twice daily) for the first 5 days, followed by lansoprazole 30mg, clarithromycin 500mg, and metronidazole 500mg (all twice daily) for the remaining 5 days. Eradication failure patients received triple therapy with lansoprazole 30mg, levofloxacin 250mg, and amoxycillin 1g (all twice daily) for 10 days.

Results: Following the sequential therapy H. pylori eradication was achieved in 70/84 (83.3%; 95% CI=75.4-91.3) patients, and in 70/77 (90.9%; 95% CI=84.5-97.3) patients at ITT and PP analyses, respectively. The infection was cured in all 7 eradication failure patients by using second-line therapy.

Conclusions: A sequential regimen as first-line therapy and a 10-day levofloxacin-based triple regimen in those patients who failed to clear the infection, appear to be a valid therapeutic strategy for management of H. pylori infection in clinical practice.

Publication types

  • Clinical Trial

MeSH terms

  • 2-Pyridinylmethylsulfinylbenzimidazoles / administration & dosage
  • 2-Pyridinylmethylsulfinylbenzimidazoles / adverse effects
  • 2-Pyridinylmethylsulfinylbenzimidazoles / therapeutic use
  • Adult
  • Aged
  • Aged, 80 and over
  • Amoxicillin / administration & dosage
  • Amoxicillin / adverse effects
  • Amoxicillin / therapeutic use
  • Anti-Bacterial Agents* / administration & dosage
  • Anti-Bacterial Agents* / adverse effects
  • Anti-Bacterial Agents* / therapeutic use
  • Anti-Ulcer Agents* / administration & dosage
  • Anti-Ulcer Agents* / adverse effects
  • Anti-Ulcer Agents* / therapeutic use
  • Clarithromycin / administration & dosage
  • Clarithromycin / adverse effects
  • Clarithromycin / therapeutic use
  • Drug Administration Schedule
  • Drug Therapy, Combination
  • Female
  • Gastrointestinal Diseases / drug therapy*
  • Gastrointestinal Diseases / etiology
  • Gastrointestinal Diseases / pathology
  • Helicobacter Infections / complications
  • Helicobacter Infections / diagnosis
  • Helicobacter Infections / drug therapy*
  • Helicobacter Infections / pathology
  • Helicobacter pylori / drug effects*
  • Humans
  • Italy
  • Lansoprazole
  • Levofloxacin
  • Male
  • Metronidazole / administration & dosage
  • Metronidazole / adverse effects
  • Metronidazole / therapeutic use
  • Middle Aged
  • Ofloxacin / administration & dosage
  • Ofloxacin / adverse effects
  • Ofloxacin / therapeutic use
  • Treatment Outcome

Substances

  • 2-Pyridinylmethylsulfinylbenzimidazoles
  • Anti-Bacterial Agents
  • Anti-Ulcer Agents
  • Lansoprazole
  • Metronidazole
  • Levofloxacin
  • Amoxicillin
  • Ofloxacin
  • Clarithromycin