The Role of Levofloxacin in First-line and “Rescue” Helicobacter pylori Treatment Regimens

Introduction Helicobacter pylori (H. pylori) infection is the main cause of gastritis, gastroduodenal ulcers, and gastric cancer. However, after more than 20 years experience with H. pylori treatment, the ideal regimen to treat this infection remains to be found. Consensus conferences have recommended therapeutic regimens that achieve H. pylori cure rates higher than 80% on an intent-to-treat (ITT) basis (1–3). However, several large clinical trials and metaanalyses have shown that the most commonly used first-line therapies − including proton pump inhibitors (PPIs) plus two antibiotics − may fail in up to 20% of patients (4, 5) and, in a routine clinical setting, the treatment failure rate might be even higher. Moreover, during the last few years, the efficacy of PPI-based regimens seems to be deAddress for correspondence Javier P. Gisbert, MD Playa de Mojácar 29. Urb. Bonanza, 28669 Boadilla del Monte, Madrid, Spain Phone: 34-915202254 Fax: 34-914022299 E-mail: [email protected] creasing, and several studies have reported ITT eradication rates lower than 75% (6–14) and some even lower than 50% (15, 16). Antibiotic resistance to clarithromycin has been identified as one of the major factors affecting our ability to cure H. pylori infection, and the rate of resistance to this antibiotic seems to be increasing in many geographical areas (17, 18). These data convincingly show that, at present, clarithromycin-based triple therapies may achieve unsatisfactory cure rates, and more effective alternatives are required. Several “rescue” therapies have been recommended, but they still fail to eradicate H. pylori in more than 20% of the cases (19), and these patients present a therapeutic dilemma (20). Patients who are not cured with two consecutive treatments including clarithromycin and metronidazole will Javier P. Gisbert, MD Gastroenterology Unit, Hospital Universitario de la Princesa and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain