TEN-DAY VERSUS 14 DAYS LEVOFLOXACIN-

CONTAINING TRIPLE THERAPY FOR

SECOND-LINE ANTI-HELICOBACTER PYLORI
ERADICATION IN TAIWAN

Wei Chen Tai, Chien Hua Chiu,
Chih Ming Liang et.al

Hindawi Publishing Corporation Gastroenterology
Research and Practice
Volume 2013
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INTRODUCTION
H.Pylori
GI disease
Peptic ulcer
Gastric adeno
Ca
MALToma
The Maastricht
IV/
Florence
Standar
therapy
1st line
PPI
Clarithromycin
Either
amoxicilin or
metronidazole
7-14
days
Bismuth-containing quadruple therapy is
also alternative
important
deciding

containing triple therapy
recomended by the Maastricht IV/ Florence Consensus


neither 7
nor 10 days
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INTRODUCTION
Antibiotic
resistance
2nd line therapy
H.Pylori
Antibiotic
resistance
Quinolone
Large meta
analysis
Fluorquinolon-
based
Tripe therapy
> 90% succes
Reports of 2nd line eradication using 14-days
levlofloxacin-containing triple therapy are few
Failed eradication 7 days using ( PPI twice daily, 500mg
INCLUDED clarithromycin twice daily. 1gr amoxicillin twice daily
at least 18 years of ages
received endoscopic exam which showed ulcers disease
or gastritis
Failure confirmed by a positive results for both the rapid
urease test and histology after 1st line eradications

EXCLUSION ingestion of antibiotics, bismuth, or PPI within 4 week
allergic history to the medication use
previous gastric surgery
the coexistence od serious concomitant illness (e.g
decompensated liver cirrhosis and uremia )
pregnancy


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MATERIAL AND METHODS
200
H.pylori
infected







Patient were follow up for the adverse effect and drug compliance after finished the
medication
all patient received either an endoscopy or urea breath test 8 weeks later, and also a
back up of urea breath test to avoid any false-negative results
poor compliance was defined as that the patient failed to finish 80% all medications
due to advers effect
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MATERIAL AND METHODS
10 days Levofloxacin 500mg once
daily, amoxicillin 1gr twice daily,
esomeprazole 40mg twice daily
( EAL-10)
14 days Levofloxacin 500mg once
daily, amoxicillin 1gr twice daily,
esomeprazole 40mg twice daily
( EAL-14)
200 patients

1.Rapid Urea Test : involved the collection of gastric antrum biopsy
specimens by endoscopy, which were tested using
agar base enriched with 40% urea solution
(eUAB,Oxoid) and a commercial rapid urase (Pronto
Dry, Medical Instrument Corp,Switzerland)
(+) if the colour changed into pink or red when
examined after 1 hour
2. Urea Breath Test : the cut-off value was set at 4.8% of 13 CO2

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MATERIAL AND METHODS
Diagnosis of Helicobacter pylori Infection


Using the SPSS version 18, the chi -square test with or without Yates correction
for continuity and Fishers exact test were used to compare the major outcomes
between groups
Eradication rates were analyzed both by Intention-to-treat ( ITT ) and per control
(PP) aproach
A P value < 0.05 was considered statistically significant
Univariate and multivariate were used to analyze the independent factor
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MATERIAL AND METHODS
Statistical Analysis
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RESULTS
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RESULTS
None of the variable showed significant difference between EAL-10 & EAL-14
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RESULTS
Abdominal pain, constipation, diarrhea, dizziness,
headache, nausea/vomiting, skin rash
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RESULTS
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RESULTS
Quinolone-containing therapy is one of the recomended second-line therapies after
the failure of the standard first-line empirical clarithromycin-containing therapy,with
bismuth-containing quadruple therapy as an alternate

Large meta analysis with fluorquinolone-containing triple therapy shown that 7 to 10
days of therapy couldt provide 90% or better treatment success

A Levofloxacin-containing triple therapy is simple and well tolerated and has high
compliance low adverse effect

in vitro, levofloxacin retains its activity even in dual H.pylori resistent strain to
clarithromycin and metonidazole

There is an in vivo synergistic effect of the quinolone and PPI on strains of H.pylori



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DISCUSSION
Gisbert et al :
levofloxacin triple scheme was superior to quadruple therapy ( 81%vs 70% ) with a lower
insidence of side effects ( 19% vs 44 % )

Today, quinolone resistace become a major concern for EAL therapy

Kuo et.al
levofloxacine resistent strain was found in 28.3% of patient.

In the current study show that the lenght of H.pylori was the clinical factor influencing the
efficacy of eradication
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DISCUSSION
Two recently published study reported that extended the length of quinolone-containing
triple therapies to 14 days could achieve eradication success up to 95% (moxifloxacin)
and 93.6% (levofloxacin)
The current study achieved an eradication rate 92.5% in EAL-14 group in PP analysis but
only 75.6% in EAL-10 group.
This study also show that 14 days should be the optimal length of treatment for quinolone-
containing triple therapies as a second-line H.pylori treatment option
quinolone resistance is carefully monitored
The current study encountered its limitation.Since our laboratory couldnt perform
CYP2C19 genotyping we used an esomeprazole based regimen,because its minimal
first-pass metabolism and had a greater gastric acid suppression effect than omeprazole

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DISCUSSION
A 14-days levofloxacin-containing triple therapy can provide >90% H.pylori
eradication rate,but 10-day treatment may be suboptimal.
The longer duration is the independent risk factor for eradication
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CONCLUSIONS