Clinical Trial: Levoflaxacin-Based Quadruple Therapy was Inferior to Traditional Quadruple Therapy in the Treatment of Resistant Helicobacter pylori Infection

Y. K. Yee; T. K. Cheung; K.-M. Chu; C. K. Chan; J. Fung; P. Chan; D. But; I. Hung; A. O. O. Chan; M. F. Yuen; A. Hsu; B. C. Y. Wong

Disclosures

Aliment Pharmacol Ther. 2007;26(7):1063-1067. 

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Our study showed that levofloxacin-based quadruple therapy was inferior to traditional quadruple therapy in the treatment of resistant H. pylori infection. This was mostly a result of the difference in eradication rate among those who had failed more than one course of eradication therapy (56% vs. 90%). Instead, the eradication rates among those patients who had only one course of previous eradication therapy were similar between EBAL and EBMT groups (84% and 87%). The efficacy was similar in those with or without previous history of levofloxacin triple therapy, while the efficacy of EBAL decreased insignificantly in those with previous history of levofloxacin triple therapy. However, this study was not sufficiently powered for this purpose.

In a systemic review of levofloxacin-based triple therapy vs. traditional quadruple therapy, the eradication rates of levofloxacin-based triple therapy varied from 63% to 91%, with a better efficacy for 10-day regimen.[18] The minimal duration of treatment was 7 days with a significant lowering of efficacy when a 4-day regimen was used.[19] The efficacy of levofloxacin-based quadruple therapy in this study was within this range. This suggested that the addition of bismuth subcitrate to levofloxacin triple therapy did not improve the efficacy significantly. Whether a 10-day quadruple levofloxacin regimen will give a better eradication outcome needs further study. The efficacy of traditional quadruple therapy varied even more markedly from 37% to 91%.[18] The eradication rate (88%) of traditional quadruple therapy in this study was higher than the rate (71%) in our previous study in 2005,[16] but similar to that (91%) in 2002.[14] The recruitment criteria were similar in these studies, but different PPIs were used in these studies. Further researches are needed to clarify whether different acid suppression is the cause of the difference.

In conclusions, levofloxacin-based quadruple therapy was inferior to traditional quadruple therapy in the treatment of resistant H. pylori infection. Successful H. pylori eradication was associated with better symptom improvement 12 weeks after therapy.


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