An Alternative Salvage Regimen for <i>Helicobacter pylori-</i>Resistant Patients with Heart Failure

Vol. 110, No. 2, 2008

Free Abstract Article (Fulltext) Article (PDF 122 KB)

Novel Insights from Clinical Experience

An Alternative Salvage Regimen for Helicobacter pylori-Resistant Patients with Heart Failure
Robert Lee Page II^a, Debra Ferguson^b, Mona Cantu^b

^aDepartment of Clinical Pharmacy, UCHSC, Schools of Pharmacy and Medicine and
^bDivision of Cardiology, UCHSC, School of Medicine, Denver, Colo., USA

Address of Corresponding Author

Cardiology 2008;110:112-115 (DOI: 10.1159/000110489)

Key Words

Helicobacter pylori
Heart failure
Levofloxacin

Abstract

Helicobacter pylori infects over 50% of the worldwide population. For eradication, European, Canadian, and American guidelines recommend a regimen consisting of a proton pump inhibitor, clarithromycin, and metronidazole or amoxicillin dosed twice daily for at least 7 days. When this treatment strategy fails, a complex, multidosed bismuth-based quadruple regimen is recommended. Unfortunately, for patients with heart failure, this salvage regimen can be potentially hazardous due to the drug-drug interaction with tetracycline and digoxin, as well as the large salicylate content with bismuth subsalicylate. As H. pylori infection is so prevalent, providers will most likely encounter such a therapeutic dilemma. A safe, effective, and simplistic alternative is a 10-day fluoroquinolone-based regimen consisting of a proton pump inhibitor, levofloxacin and either clarithromycin or amoxicillin. Levofloxacin demonstrates excellent bioavailability, widespread tissue and fluid distribution, extended half-life, limited drug interaction profile, low incidence of side effects, and remarkable activity against H. pylori with minimal primary resistance. Compared to the 7-day quadruple regimen, a 10-day levofloxacin-based regimen demonstrated a greater eradication rate, better tolerability, and a lower rate of therapy discontinuation. We briefly provide a summary of the data regarding this levofloxacin-based regimen and two successful cases from our heart failure clinic.

Author Contacts

Robert L. Page II
UCHSC, School of Pharmacy
4200 East Ninth Ave, Box C238
Denver, CO 80262 (USA)
Tel. +1 303 315 0241, Fax +1 303 315 4630, E-Mail robert.page@uchsc.edu

Article Information

Received: March 26, 2007
Accepted after revision: June 7, 2007
Published online: October 31, 2007
Number of Print Pages : 4
Number of Figures : 0, Number of Tables : 2, Number of References : 18

Medline Abstract (ID 17971660)

Download Citation

This journal is part of the third subject package of the Karger

Journal Archive Collection

Information on packages (PDF)
Free sample issues

For non-native English speakers and international authors who would like assistance with their writing before submission, we suggest American Journal Experts for their scientific editing service.