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Systematic review and meta‐analysis: levofloxacin‐based rescue regimens after Helicobacter pylori treatment failure
Author(s) -
GISBERT J. P.,
MORENA F.
Publication year - 2006
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1111/j.1365-2036.2006.02737.x
Subject(s) - levofloxacin , medicine , regimen , helicobacter pylori , meta analysis , adverse effect , amoxicillin , randomized controlled trial , subgroup analysis , antibiotics , microbiology and biotechnology , biology
Summary Background A quadruple therapy has been generally recommended as rescue regimen for Helicobacter pylori eradication failures. Aims To systematically review the efficacy and tolerance of levofloxacin‐based rescue regimens, and to conduct a meta‐analysis of studies comparing these regimens with quadruple therapy for H. pylori eradication failures. Methods Selection of studies – levofloxacin‐based rescue regimens. For the meta‐analysis, randomized‐controlled trials comparing levofloxacin‐based and quadruple regimens. Search strategy – electronic and manual. Assessment of study quality – independently by two reviewers. Data synthesis –‘intention‐to‐treat’ eradication rate. Results Mean eradication rate with levofloxacin‐based regimens was 80%. Ten‐day regimens were more effective than 7‐day combinations (81% vs. 73%; P < 0.01). The meta‐analysis showed better results with levofloxacin than with the quadruple combination (81% vs. 70%; OR = 1.80; 95% CI = 0.94–3.46). This difference reached statistical significance and heterogeneity markedly decreased when a single outlier study was excluded or when only high‐quality studies were considered. Meta‐analysis showed less adverse effects with levofloxacin than with quadruple regimen, both overall (19% vs. 44%; OR = 0.27; 95% CI = 0.16–0.46) and regarding severe adverse effects (0.8% vs. 8.4%; OR = 0.20; 95% CI =0.06–0.67). Conclusions After H. pylori eradication failure, levofloxacin‐based rescue regimen is more effective and better tolerated than the generally recommended quadruple therapy. A 10‐day combination of levofloxacin–amoxicillin–proton pump inhibitor constitutes an encouraging second‐line alternative.