Second-Line Levofloxacin-Based Triple Therapy’s Efficiency for Helicobacter pylori Eradication in Patients With Peptic Ulcer Fatih Ermis, MD, Filiz Akyuz, MD, Ahmet Uyanikoglu, MD, Ramazan Kurt, MD, Binnur Pinarbasi, MD, Hasan Nazik, MD, Sabahattin Kaymakoglu, MD, and Zeynel Mungan, MD Objectives: First-line standard eradication efficacy with lansopra- zole, amoxicillin and clarithromycin regressed over 10 years. The aim of this study was to evaluate the efficacy and tolerability of a levo- floxacin-based regimen in patients with peptic ulcer after failure of the standard first-line H.pylori eradication therapy in a country with a high rate of infection. Methods: A total of 91 peptic ulcer patients who were diagnosed H.pylori positive proven by rapid urease test and histology between November 2005 to March 2008 were given lansoprazole 30 mg bid, amoxicillin 1 g bid and clarithromycin 500 mg bid (LAC) for 14 days. After three months from the first line eradication treatment omepra- zole 20 mg bid, levofloxacin 500 mg bid, amoxicillin 1 g bid (OLA) 7 day treatment regimen was recommended as a second-line therapy for 37 patients who failed at first-line standard triple therapy. Results: Eradication rates for LAC regimen were found to be 57.14% (52/91) for intention to treat and 58.42% (52/89) for per protocol analysis. Eradication rates for OLA regimen were found to be 37.83% (14/37) for ITT and 41.17% (14/34) for PP analysis. Conclusion: OLA regimen eradication rate was successful only in 40% of patients who failed in the first-line eradication. New eradi- cation treatment strategies must be performed, at least in Turkey. Key Words: H.pylori, levofloxacin, peptic ulcer, second-line treatment H elicobacter pylori (H. pylori) is a spiral-shaped bacteri- um that is attached to or just above the gastric mucosa. 1 The most solid argument supporting the causal role of this microorganism in peptic ulcer disease is the evidence that eradicating H.pylori is associated with a dramatic decrease in the rate of peptic ulcer relapses. 2 H.pylori infection has been also shown to be closely related with gastric malignancies such as gastric adenocarcinoma and low-grade gastric mucosa associated lymphoid tissue (MALT) lymphoma. Furthermore, regression of MALT lymphoma had been demonstrated after successful H.pylori eradication. 3 The discovery of H.pylori has been considered a revolution in gastroenterology because treatment strategies of some gastrointestinal diseases had been changed thereafter. 4 Since its discovery, the European Heli- cobacter Study Group arranged the Maastricht Consensus conferences to issue and update guidelines on H.pylori infec- tion. 5,6 The most recent Maastricht Consensus conference was held in Florence, Italy. According to Maastricht III-2005 Consensus Report, standard first-line treatment is a triple therapy consisting of clarithromycin and amoxicillin or metronidazole in combination with a proton pump inhibitor Key Points & The most solid argument supporting the causal role of this microorganism in peptic ulcer disease is the evidence that eradicating H.pylori is associated with a dramatic decrease in the rate of peptic ulcer relapses. & First-line standard eradication efficacy with lansoprazole, amoxicillin and clarithromycin regressed over the last decade. & A practical approach to initial treatment for H.pylori in- fection and those who failed this initial eradication therapy is a matter of discussion in the consensus meetings. & Although levofloxacin was found to be promising in some European studies, the most popular standard eradication regimen was ineffective in a country with a high rate of infection. New eradication treatment strategies must be performed, at least in Turkey. Original Article Southern Medical Journal & Volume 104, Number 8, August 2011 579 From the Department of Gastroenterology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey; and Department of Microbiology and Clinical Microbiology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey. Reprint requests to Fatih Ermis, MD, Department of Gastroenterology, Istanbul Medical Faculty, Millet Street, Fatih 34093 Istanbul-Turkey. Email: fatihermis2@hotmail.com The authors have no financial disclosures to declare and no conflicts of interest to report. Accepted May 9, 2011. Copyright * 2011 by The Southern Medical Association 0038-4348/0Y2000/104-579 DOI: 10.1097/SMJ.0b013e3182249be0 Copyright © 2011 The Southern Medical Association. Unauthorized reproduction of this article is prohibited.