Levofloxacin-based triple therapy versus bismuth-based quadruple therapy as a second line treatment for the eradication of H. pylori infection

Abstract

INTRODUCTION: Levofloxacin-based triple therapy has been suggested as an alternative second line treatment to bismuth- based quadruple therapy for persistent Helicobacter pylori (H. pylori) infection. AIM: To compare levofloxacinbased triple therapy (levofloxacin + amoxicillin + PPI) to bismuth-based quadruple therapy (bismuth + tetracycline + metronidazole + PPI) as a second line treatment for the eradication of H. pylori. METHODS: In our study we included 77 patients who failed to eradicate H. pylori following 7-10 days of previous treatment with PPI plus amoxicillin plus clarithromycin. All patients were randomly assigned either to levofloxaxin triple (levofloxacin 500mg bid+amoxicillin 1gr bid + lansoprazole 30mg bid) therapy (Group A, N=39) or to classical bismuth based quadruple regimen (bismuth 120 mg X 4 + tetracycline 500mg tid + metronidazole 500mg tid + lansoprazole 30mg bid) (N=38, Group B). Both groups were treated for 10 days. Eradication of H. pylori was assessed by 13Curea breath test 4-6 weeks after therapy. RESULTS: The H. pylori eradication rates on the intention to treat analysis (ITT) were 37/39 (94.87%) in Group A and 30/38 (78.9%) in group B (P<0.05). The per protocol eradication rates were 97.3% and 85.7% respectively (NS). Side effects were significantly higher in the quadruple regimen (3 patients discontinued treatment due to side effects versus none in the levofloxacin regimen). CONCLUSION: A 10-day course of levofloxacin triple therapy appeared to be more effective and better tolerated than a 10-day bismuth-based quadruple therapy in the treatment of persistent H. pylori infection.