Levofloxacin sequential therapy vs levofloxacin triple therapy in the second-line treatment of helicobacter pylori: A randomized trial

Jyh Ming Liou, Ming Jong Bair, Chieh Chang Chen, Yi Chia Lee, Mei Jyh Chen, Chien Chuan Chen, Cheng Hao Tseng, Yu Jen Fang, Ji Yuh Lee, Tsung Hua Yang, Jiing Chyuan Luo, Jeng Yih Wu, Wen Hsiung Chang, Chun Chao Chang, Chi Yi Chen, Po Yueh Chen, Chia Tung Shun, Wen Feng Hsu, Hsu Wei Hung, Jaw Town LinChi Yang Chang, Ming Shiang Wu

研究成果: 雜誌貢獻文章

23 引文 斯高帕斯(Scopus)

摘要

Objectives:The efficacy of levofloxacin triple therapy has fallen below 80% in the second-line treatment of Helicobacter pylori (H. pylori). We aimed to assess whether the levofloxacin sequential therapy is more effective than levofloxacin triple therapy in the second-line treatment.Methods:This open-label, randomized, multicenter trial was conducted between 2012 and 2015. H. pylori-infected subjects who failed from clarithromycin-based regimens (N=600) were randomized (1:1) to receive levofloxacin sequential therapy (LS: lansoprazole and amoxicillin for the first 5 days, followed by lansoprazole, levofloxacin, and metronidazole for another 5 days) or levofloxacin triple therapy (LT: lansoprazole, amoxicillin, and levofloxacin for 10 days). Successful eradication was defined as negative 13 C-urea breath test at least 6 weeks after treatment. Our primary outcome was the eradication rate by intention-to-treat (ITT) and per-protocol (PP) analyses. Antibiotic resistance was determined by agar dilution test.Results:The prevalence of clarithromycin, levofloxacin, and metronidazole resistance was 60, 17.6, and 36.9%, respectively. The eradication rates of LS and LT were 84.3% (253/300) and 75.3% (226/300), respectively, in the ITT analysis (P=0.006) and 86.3% (253/293) and 78.8% (223/283), respectively, in the PP analysis (P=0.021). The efficacies of both LS and LT were affected by levofloxacin resistance. The secondary resistance of levofloxacin was 66.7 and 73.9% after LS and LT, respectively. The efficacies of LS and LT were not affected by the CYP2C19 polymorphism.Conclusions:Levofloxacin sequential therapy was more effective than levofloxacin triple therapy, and it is recommended in the second-line treatment for H. pylori (Trial registration number: NCT01537055).
原文英語
頁(從 - 到)381-387
頁數7
期刊American Journal of Gastroenterology
111
發行號3
DOIs
出版狀態已發佈 - 三月 1 2016

    指紋

ASJC Scopus subject areas

  • Medicine(all)
  • Gastroenterology

引用此

Liou, J. M., Bair, M. J., Chen, C. C., Lee, Y. C., Chen, M. J., Chen, C. C., Tseng, C. H., Fang, Y. J., Lee, J. Y., Yang, T. H., Luo, J. C., Wu, J. Y., Chang, W. H., Chang, C. C., Chen, C. Y., Chen, P. Y., Shun, C. T., Hsu, W. F., Hung, H. W., ... Wu, M. S. (2016). Levofloxacin sequential therapy vs levofloxacin triple therapy in the second-line treatment of helicobacter pylori: A randomized trial. American Journal of Gastroenterology, 111(3), 381-387. https://doi.org/10.1038/ajg.2015.439