Role of the Preliminary Susceptibility Testing for Initial and After Failed Therapy of Helicobacter pylori Infection with Levofloxacin, Amoxicillin, and Esomeprazole

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Abstract

Background

Levofloxacin has been proposed as an alternative to classic therapy in secondary resistance to Helicobacter pylori.

Aim

To evaluate primary and secondary resistance of H. pylori to levofloxacin, and to test the role of susceptibility test on the efficacy of levofloxacin-based triple therapy.

Methods

Eighty consecutive dyspeptic patients with positive 13C-urea breath test never treated were randomly allocated into group A1 (40 patients) and group B1 (39 patients). Eighty-three patients already treated unsuccessfully with positive 13C-urea breath test were divided into group A2 (51 patients) and group B2 (32 patients). Patients in group A1 and group A2 underwent upper gastrointestinal endoscopy for H. pylori susceptibility test to amoxicillin, clarithromycin, tinidazole, rifabutin, and levofloxacin. These patients were treated with levofloxacin (500 mg b.i.d.), amoxicillin (1 g b.i.d.) and esomeprazole (20 mg b.i.d.) for 10 days if sensitive to these two antibiotics. If H. pylori was found resistant to amoxicillin and/or levofloxacin the treatment was based on the indications of the susceptibility test. Patients in group B1 and group B2 were treated empirically with levofloxacin, amoxicillin, and esomeprazole at the same dose and duration as group A. All patients underwent 13C-urea breath test 2 months after the end of therapy.

Results

The antibiotic resistance of H. pylori strains in group A1 and group A2 was (%): amoxicillin: 2.4, 10; clarithromycin: 21.9, 43.1; tinidazole: 31.7, 70; rifabutin: 2.4, 4; and levofloxacin: 9.7, 12.2, respectively. In group A1 with susceptibility test-driven therapy, eradication was 97.2%, and in group B1 with empirical treatment, 94.1% (n.s.). In group A2 with susceptibility test, eradication was 97.5%, whereas in group B2 with empirical treatment 81.2% (p < .01).

Conclusion

Primary and secondary resistance of H. pylori to levofloxacin is approximately 10% of the tested strains. The susceptibility test does not influence therapeutic outcome of triple therapy with amoxicillin and levofloxacin in patients never treated, while it is determinant for patients who were previously treated without success.

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