Published online Jun 7, 2015. doi: 10.3748/wjg.v21.i21.6698
Peer-review started: December 18, 2014
First decision: January 8, 2015
Revised: January 23, 2015
Accepted: February 13, 2015
Article in press: February 13, 2015
Published online: June 7, 2015
AIM: To evaluate a levofloxacin-doxycycline-based triple therapy with or without a susceptibility culture test in non-responders to Helicobacter pylori (H. pylori) eradication.
METHODS: A total of 142 (99 women, 43 men; mean 53.0 ± 12.7 years) non-responders to more than two H. pylori eradication therapies underwent susceptibility culture tests or were treated with a seven-day triple therapy consisting of esomeprazole, 20 mg b.i.d., levofloxacin, 500 mg b.i.d., and doxycycline, 100 mg b.i.d., randomly associated with (n = 71) or without (n = 71) Lactobacillus casei DG. H. pylori status was checked in all patients at enrollment and at least 8 wk after the end of therapy. Compliance and tolerability of regimens were also assessed.
RESULTS: H. pylori eradication was achieved in < 50% of patients [per prototol (PP) = 49%; intention to treat (ITT) = 46%]. Eradication rate was higher in patients administered probiotics than in those without (PP = 55% vs 43%; ITT = 54% vs 40%). Estimated primary resistance to levofloxacin was 18% and multiple resistance was 31%. Therapy was well tolerated, and side effects were generally mild, with only one patient experiencing severe effects.
CONCLUSION: Third-line levofloxacin-doxycycline triple therapy had a low H. pylori eradication efficacy, though the success and tolerability of this treatment may be enhanced with probiotics.
Core tip:Helicobacter pylori eradication therapy should be based on a culture sensitivity test or include antibiotics not already used by patients who failed to respond to two or more previous attempts. Third-line levofloxacin-based triple therapy was demonstrated to be effective in such kind of patients. In the present study, a third-line levofloxacin-doxycycline triple therapy, associated or not with probiotics, was able to eradicate H. pylori infection in about 50% of patients. The low eradication rate achieved by the study regimen was probably due to levofloxacin resistance. Further studies on larger series are needed to confirm the efficacy of levofloxacin-containing regimens in Italy.