Efficacy of H. pylori eradication with a sequential regimen followed by rescue therapy in clinical practice

Abstract 

Background

Current Italian guidelines suggest sequential therapy as first-line therapy and a levofloxacin-based rescue therapy for Helicobacter pylori eradication. We evaluated the efficacy of these therapies in clinical practice.

Methods

84 consecutive patients with dyspeptic symptoms and proven H. pylori infection by either UBT or upper endoscopy with biopsies were enrolled. Patients received a 10-day sequential therapy with lansoprazole 30mg plus amoxycillin 1g (all twice daily) for the first 5 days, followed by lansoprazole 30mg, clarithromycin 500mg, and metronidazole 500mg (all twice daily) for the remaining 5 days. Eradication failure patients received triple therapy with lansoprazole 30mg, levofloxacin 250mg, and amoxycillin 1g (all twice daily) for 10 days.

Results

Following the sequential therapy H. pylori eradication was achieved in 70/84 (83.3%; 95% CI=75.4–91.3) patients, and in 70/77 (90.9%; 95% CI=84.5–97.3) patients at ITT and PP analyses, respectively. The infection was cured in all 7 eradication failure patients by using second-line therapy.

Conclusions

A sequential regimen as first-line therapy and a 10-day levofloxacin-based triple regimen in those patients who failed to clear the infection, appear to be a valid therapeutic strategy for management of H. pylori infection in clinical practice.

Keywords: Helicobacter pylori, Levofloxacin-based therapy, Rescue therapy, Sequential therapy