Systematic review and meta-analysis:: levofloxacin-based rescue regimens after Helicobacter pylori treatment failure

Background A quadruple therapy has been generally recommended as rescue regimen for Helicobacter pylori eradication failures. Aims To systematically review the efficacy and tolerance of levofloxacin-based rescue regimens, and to conduct a meta-analysis of studies comparing these regimens with quadruple therapy for H. pylori eradication failures. Methods Selection of studies levofloxacin-based rescue regimens. For the meta-analysis, randomized-controlled trials comparing levofloxacin-based and quadruple regimens. Search strategy - electronic and manual. Assessment of study quality - independently by two reviewers. Data synthesis - 'intention -to-treat' eradication rate. Results Mean eradication rate with levofloxacin-based regimens was 80%. Tenday regimens were more effective than 7-day combinations (810/6 vs. 73%; P < 0.0 1). The meta-analysis showed better results with levofloxacin than with the quadruple combination (81% vs. 70%; OR = 1.80; 95% CI = 0.94-3.46). This difference reached statistical significance and heterogeneity markedly decreased when a single outlier study was excluded or when only high-quality studies were considered. Meta-analysis showed less adverse effects with levofloxacin than with quadruple regimen, both overall (19% vs. 44%; OR = 0.27; 95% Cl = 0.16-0.46) and regarding severe adverse effects (0.80/6 vs. 8.4%; OR = 0.20; 95% Cl =0.06-0.67). Conclusions After H. pylori eradication failure, levofloxacin-based rescue regimen is more effective and better tolerated than the generally recommended quadruple therapy. A 10-day combination of levofloxacin-amoxicillin-proton pump inhibitor constitutes an encouraging second-line alternative.