Abstract
Bismuth + proton pump inhibitor (PPI) + amoxicillin + levofloxacin is one of the bismuth quadruple therapy regimens widely used for the eradication of H. pylori infection. The recommended dosage of levofloxacin is 500 mg once daily or 200 mg twice daily to eradicate H. pylori infection. The aim of the present open-label, randomized control trial was to compare the effectiveness, safety, and compliance of different dosages of levofloxacin used to cure Helicobacter pylori infection. Eligible patients were randomly assigned to receive esomeprazole, amoxicillin, colloidal bismuth pectin and levofloxacin 500 mg once/day (group A) or levofloxacin 200 mg twice/day (group B) for 14 days. The primary outcome was the eradication rates in the intention-to-treat (ITT) and per protocol (PP) analyses. Overall, 400 patients were enrolled. The eradication rates in group A and group B were 77.5% and 79.5% respectively, in the ITT analysis, and 82.9% and 86.4%, respectively, in the PP analysis. No significant differences were found between two groups in terms of eradication rate, adverse effects or compliance. Oral levofloxacin 200 mg twice daily was similar in efficacy for eradicating H. pylori infection to oral levofloxacin 500 mg once daily but with lower mean total costs.
Highlights
Epidemiological studies have indicated that the prevalence of Helicobacter pylori (H. pylori) infection has an incidence of 20–50% in developed countries and 40–60% in China[1,2]
The patients with dyspepsia referred for an upper endoscopy and diagnosed with chronic gastritis with dyspepsia or mucosal atrophy/erosion were eligible for enrollment if they had an H. pylori infection, were 20–60 years old, and had never previously received eradication treatment for H. pylori infection
Bismuth + pump inhibitor (PPI) + amoxicillin + levofloxacin is one of the bismuth quadruple therapy (BQT) regimens widely used for the eradication of H. pylori infection
Summary
Epidemiological studies have indicated that the prevalence of Helicobacter pylori (H. pylori) infection has an incidence of 20–50% in developed countries and 40–60% in China[1,2]. The drug resistance rates against metronidazole, clarithromycin, and levofloxacin have increased substantially in many regions. In China, the rates of resistance to metronidazole, clarithromycin, and levofloxacin are 60–70%, 20–38%, and 30–38%, respectively[14,15,16]. The eradication rate of standard triple therapy has fallen to lower or far lower than 80% in many countries because of the drug resistance rate of H. pylori[17]. The Maastricht V/Florence Consensus Report recommended bismuth quadruple therapy (BQT) as the first-line treatment for the eradication of H. pylori infection in areas of high dual clarithromycin and metronidazole resistance[18]. The Fourth Chinese National Consensus Report on the management of H. pylori infection recommended that bismuth + proton pump inhibitor (PPI) + amoxicillin + levofloxacin could be one of the BQT regimens used as a first-line treatment for the eradication of H. pylori infection. All authors had access to the study data and reviewed and approved the final manuscript
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