Levofloxacin‐based Helicobacter pylori eradication in chronic dyspepsia

Abstract

Introduction Helicobacter pylori infection in dyspepsia is an important clinical problem with increasing antibiotic resistance. Aim To evaluate the efficacy of levofloxacin‐based triple therapy compared with clarithromycin‐based triple therapy for Helicobacter pylori eradication in chronic dyspepsia. Methods This was a prospective, single‐blinded randomized trial. Rapid urease test and histology were performed in patients with chronic dyspepsia who underwent gastroscopy. H pylori‐infected patients were randomly allocated into two equal groups prescribing 10‐day course of levofloxacin‐based or clarithromycin‐based regime. Endoscopic responses and eradication status of both regimes were rechecked with gastroscopy 4 weeks after therapies. Result Two hundred and ninety‐one treatment‐naïve patients were enrolled. Eradication rates were 40% vs 47.5% on intention to treat (ITT) analysis and 43.7% vs 50.8% on per‐protocol (PP) for clarithromycin group vs levofloxacin group, respectively. In levofloxacin arm, eradication occurred in 62.5% (ITT) & 71.4% (PP) of ulcer dyspepsia and 43.2% (ITT) and 46.6% (PP) of nonulcer dyspepsia. Among ulcer dyspepsia, 58.3% healed in clarithromycin group and 64.3% in levofloxacin group. In nonulcer dyspepsia, gastritis was resolved in 21% of clarithromycin group and 10% of levofloxacin group. Adverse effects occurred in 30% of clarithromycin group and 27.6% of levofloxacin group. Conclusion In the study, eradication rates of both therapies were very low to unacceptable level. Levofloxacin was not effective in both ulcer and nonulcer dyspepsia. The emergence of primary levofloxacin resistant strains due to widespread usages in various infections might be the reason.

Helicobacter pylori infection increases the risk of thyroid nodules in adults of Northwest China

“…All participant information was obtained from the clinical record database of the second affiliated hospital of Xi'an Jiaotong University. H. pylori infection was diagnosed by 14 C-UBT, which had been considered the "gold standard" in clinical practice (Aung et al, 2021). In 14 C-UBT, all participants were required to fast for more than 6 hours before taking 14 C urea capsule.…”

GastroHep Asian Special Edition

“…GastroHep will conclude a third year with a fully packed Asian Helicobacter pylori is extremely prevalent in Asia and thus there are a number of papers reporting eradication regimes used and their relative effectiveness. [1][2][3] Also there is a study of CYP2C19 polymorphism and its effects on therapy. 4 Studies on non-invasive diagnosis of atrophic gastritis could lead to better detection of precancerous conditions and looking at the relationship between chronic dyspeptic symptoms and underlying precancerous gastric conditions are important studies to undertake.…”