Tailored Therapy for Levofloxacin-susceptible Strains Can Achieve Greater Than 90% Success Rates of Second Line Helicobacter Pylori Eradication in both 10-day and 14-day Levofloxacin-containing triple therapy

Second line Helicobacter pylori eradication with fluoroquinolone-containing triple therapy is one of the recommended treatment options but 10-day regimens cannot provide >90% success rates. Current study aimed to explore the influential role of antibiotic susceptibility in levofloxacin-containing triple therapies for second line H. pylori eradication.
We enrolled 158 patients who failed standard first-line H. pylori eradication were prescribed with either a 10-day or 14-day levofloxacin-containing triple therapy groups (levofloxacin 500 mg once daily, amoxicillin 1 g twice daily, and esomeprazole 40 mg twice daily for 10 or 14 days). Treatment responses were follow-up 8 weeks later.
Eradication rates attained by EAL-10 and EAL-14 were 73.6%; 95% CI=63.9-85.3% and 90.5 %; 95% CI=84.5-98.1%, p=0.008 in the per protocol analysis; 67.1%; 95% CI=56.6-78.5% and 84.8%; 95% CI=76.8-93.4%, p=0.009 in the intention-to-treat analysis. Levofloxacin-resistant strain was 31.8% (14/44). Subgroup analysis showed that H. pylori were eradicated among all the EAL-14 patients with levofloxacin-susceptible strains but occurred in only 50% with levofloxacin-resistant strains.
This study confirms the effectiveness of EAL-14 treatment and observed that 10-day treatment duration is sufficient (>90%) if culture can prove susceptible strains. This study suggests that one should do tailored therapy and only admit patients with susceptible strains for levofloxacin-containing triple therapy.