Third-line rescue therapy with levofloxacin is more effective than rifabutin rescue regimen after two Helicobacter pylori treatment failures

被引:78
作者
Gisbert, J. P. [1 ]
Gisbert, J. L. [1 ]
Marcos, S. [1 ]
Moreno-Otero, R. [1 ]
Pajares, J. M. [1 ]
机构
[1] Univ Autonoma Madrid, Dept Gastroenterol, Princesa Univ Hosp, Madrid, Spain
关键词
D O I
10.1111/j.1365-2036.2006.03149.x
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Background: In patients with a first eradication failure, a second (rescue) therapy still fails in > 20% of cases. Aim: To compare rifabutin and levofloxacin rescue regimens in patients with two consecutive Helicobacter pylori eradication failures. Methods: Patients, in whom first treatment with omeprazole-clarithromycin-amoxicillin and a second trial with omeprazole-bismuth-tetracycline-metronidazole (or ranitidine bismuth citrate with these antibiotics) had failed, received 10 days of treatment with either rifabutin (150 mg b.d.) or levofloxacin (500 mg b.d.), plus amoxicillin (1 g b.d.) and omeprazole (20 mg b.d.). Cure rates were evaluated by the C-13-urea breath test. Results: Twenty patients received rifabutin, and 20 levofloxacin. All the patients returned for follow-up. Compliance in the rifabutin group was 100%. Four patients in the levofloxacin group did not take the medication correctly (in two cases due to adverse effects: myalgia and rash). Side effects in the rifabutin and levofloxacin groups were reported in 60% and 50% of the cases, respectively. Five patients (25%) treated with rifabutin presented with leucopenia, and six (30%) treated with levofloxacin presented with myalgias. Per-protocol cure rates were 45% (95% confidence interval, 26-66%) in the rifabutin group, and 81% (57-93%) in the levofloxacin group (P < 0.05). Intention-to-treat cure rates were, 45% (26-66%) and 85% (64-95%), respectively (P < 0.01). Conclusions: After two previous H. pylori eradication failures, a 10-day triple levofloxacin-based rescue regimen is more effective than the same regimen with rifabutin.
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页码:1469 / 1474
页数:6
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