Levofloxacin-based triple therapy versus bismuth-based quadruple therapy in the treatment of Helicobacter pylori as the rescue therapy: a meta analysis

Abstract

Objective: To evaluate the efficacy of levofloxacin-based triple therapy and bismuth-based quadruple therapy in the treatment of Helicobacter pylori (Hp) infection as rescue regimens. Methods: Related randomized controlled trials assessing the efficacy and safety of levofloxacin-based triple therapy eradicating Hp as salvage treatment were retrieved from Pubmed, Cochrane Library, SPRINGER, VIP database, WanFang database and CKNI database. The literature quality was evaluated by the improved Jadad criterion. RevMan5.3 sofeware was applied to data analysis. The mergment model was chosen on the basis of the outcome of the heterogeneity tests and original data was pooled for meta-analysis. Publication bias assessed with funnel plots. Results: Ultimately seventeen literatures were included for meta-analysis, the analysis showed that the eradication rate of levofloxacin-based triple therapy was higher comparing to the bismuth-based quadruple therapy but the difference was not statistically significant(77.0% vs 68.7%, OR=1.52, 95%CI 0.96-2.42, P=0.34). In European countries, levofloxacin-based triple therapy was more effective than quadruple therapy(80.6% vs 68.5%, OR=2.18, 95%CI 1.25-3.81, P<0.05), while eradication rates of two groups in Asian countries were similar. The 7-day levofloxacin-based triple therapy and quadruple therapy showed comparable efficacy, whereas the 10-day levofloxacin-based triple therapy was significantly more effective than quadruple therapy(87.7% vs 61.3%, OR=4.92, 95% CI 3.09-7.82, P<0.05). The efficacy was not influenced by the dose of levofloxacin. The adverse effects were significantly lesser(19.1% vs 29.5%, OR=0.47, 95%CI 0.26-0.82, P<0.05), whereas the compliance rate was significantly higher in levofloxacin group (96.0% vs 89.9%, OR=2.27, 95%CI 1.33-3.87, P<0.05). Conclusions: Comparing with bismuth-based quadruple therapy, levofloxacin-based triple therapy has higher eradication rate, compliance rate and lesser side effects, so we recommend it as a second-line rescue therapy after front-line Hp eradication failure. The optimal second-line alternative scheme might differ among countries depending on quinolone resistance.