Levofloxacin/amoxicillin-based schemes vs quadruple therapy for Helicobacterpylori eradication in second-line

• Published in: 世界胃肠病学杂志：英文版 2012, Vol.18 (40), p.5669-5678
• Main Author: Simona Di Caro Lucia Fini Yayha Daoud Fabio Grizzi Antonio Gasbarrini Antonino De Lorenzo Laura Di Renzo Sara McCartney Stuart Bloom
• Format: Article
• Language: English
• Subjects: 发展中国家; 基础; 左氧氟沙星; 幽门螺旋杆菌; 幽门螺杆菌; 根除; 疗法; 阿莫西林
• ISSN: 1007-9327; 2219-2840

Worldwide prevalence of Helicobacter pylori （H. pylori） infection is approximately 50%, with the highest be- ing in developing countries. We compared cure rates and tolerability （SE） of second-line anti-H, pylori le- vofloxacin/amoxicillin （LA）-based triple regimens vs standard quadruple therapy （QT）. An English language literature search was performed up to October 2010. A meta-analysis was performed including randomized clinical trials comparing 7- or 10-d LA with 7-d QT. In total, 10 articles and four abstracts were identi- fied. Overall eradication rate in LA was 76.5% （95% CI： 64.4%-97.6%）. When only 7-d regimens were in-cluded, cure rate was 70.6% （95% CI： 40.2%-99.1%）, whereas for 10-d combinations, cure rate was sig- nificantly higher （88.7%; 95% CI： 56.1%-109.9%; P 〈 0.05）. Main eradication rate for QT was 67.4% （95% CI： 49.7%-67.9%）. The 7-d LA and QT showed comparable efficacy [odds ratio （OR）： 1.09; 95% CI： 0.63-1.87], whereas the 10-d LA regimen was sig- nificantly more effective than QT （OR： 5.05; 95% CI： 2.74-9.31; P 〈 0.001; I2 = 75%）. No differences were reported in QT eradication rates among Asian and European studies, whereas LA regimens were more effective in European populations （78.3% vs 67.7%; P = 0.05）. Incidence of SE was lower in LA therapy than QT （OR： 0.39; 95% CI： 0.18-0.85; P = 0.02）. A higher rate of side effects was reported in Asian patients who received QT. Our findings support the use of 10-d LA as a simple second-line treatment for H. pylori eradica- tion with an excellent eradication rate and tolerability. The optimal second-line alternative scheme might differ among countries depending on quinolone resis- tance.