CHICAGO — Levofloxacin-based therapy is superior to the other commonly used antibiotic combinations for Helicobacter pylori eradication, both as first and as second-line treatment, according to presentations at the annual Digestive Disease Week.
Levofloxacin-based therapy is becoming popular as salvage therapy after initial antibiotic therapy has failed, as occurs in perhaps 25% of initial treatments, said Richard J. Saad, M.D., of the division of gastroenterology at the University of Michigan, Ann Arbor. But reports on its efficacy rate have varied, and it has not been clear how triple therapy using levofloxacin compares with the more standard quadruple therapy used for patients who have failed eradication.
So Dr. Saad and colleagues performed a metaanalysis of trials reported since 2002.
Their analysis showed that triple treatment with levofloxacin (Levaquin), amoxicillin, and a proton-pump inhibitor for 10 days was 40% more likely to result in H. pylori eradication than quadruple therapy with bismuth subsalicylate, tetracycline, metronidazole, and a proton-pump inhibitor.
The analysis indicated that the levofloxacin-based therapy has a success rate of 87%, compared with a rate of 60% for standard quadruple therapy, Dr. Saad said.
Patients who used a levofloxacin also were 52% less likely to have side effects, and 70% less likely to discontinue therapy due to side effects.
In addition, the analysis showed that 10 days treatment with the levofloxacin-based therapy was significantly superior to 7 days (an eradication rate of 87%, vs. 68%), and that twice daily dosing of the levofloxacin (250 mg) was somewhat better than once daily dosing (500 mg), but only marginally so. Dr. Saad reported no conflicts of interest concerning the medications studied.
In a separate presentation, levofloxacin-based initial therapy had a higher eradication rate than two other commonly used combinations, Antonio Gasbarrini, M.D., said at the meeting.
His group found that a 7-day course of treatment with levofloxacin (500 mg, once daily), clarithromycin (500 mg, twice daily), and esomeprazole (20 mg, twice daily) resulted in eradication of H. pylori in 87 out of 100 patients, said Dr. Gasbarrini, of Gemelli Hospital, Catholic University of the Sacred Heart, Rome.
In comparison, a 7-day course of treatment with clarithromycin (500 mg, twice daily), amoxicillin (1 g, twice daily), and esomeprazole (20 mg, twice daily) resulted in eradication in 75 out of 100 patients, and a 7-day course of clarithromycin (500 mg, twice daily), metronidazole (500 mg, twice daily), and esomeprazole (20 mg, twice daily) resulted in eradication in 72 out of 100 patients.
Antibiotic resistance is the main reason initial treatment of H. pylori fails, and the known resistance rates in Italy (10%–30%) probably justify using the levofloxacin-based regimen as the first-line therapy, said Dr. Gasbarrini, who reported no conflicts of interest.