Levofloxacin versus clarithromycin for Helicobacter pylori eradication: are 14 day regimens better than 10 day regimens?

Abstract

Background Helicobacter pylori eradication by the conventional clarithromycin therapy has largely dropped in the recent years possibly due to antimicrobial resistance. Hence, levofloxacin-based regimen has been used as salvage therapy. However, data regarding its effectiveness on eradication are controversial. This study aimed to compare the eradication rate of levofloxacin-based regiment to that of the conventional first-line clarithromycin regimen. Methods Patients diagnosed with H. pylori infection and treated with levofloxacin triple therapy or clarithromycin-based regimen for 10 or 14 days were included. Patients were excluded if they used antibiotics or proton pump inhibitors within 4 or 2 weeks, respectively, of the H. pylori eradication confirmation test. H. pylori eradication rate was assessed, as well as the impact of diabetes and esophagogastroduodenoscopy (EGD) findings. Results Of 245 patients, 145 were in the levofloxacin group and 100 in the clarithromycin group. Most patients in either group received therapy for 14 days vs. 10 days (P = 0.002). Levofloxacin-based treatment was associated with a higher eradication rate compared with clarithromycin-based treatment (74.5 vs. 62%, respectively; P = 0.04). The 14 day levofloxacin-based regimen resulted in the highest eradication rate, followed by the 14 day regimen of clarithromycin (80.9 vs. 66.3%; P = 0.03). The 10 day regimens exhibited 62.7 and 41.2% eradication rates, respectively (P = 0.12). H. pylori eradication was not affected by diabetes or EGD findings (P = 0.98 and 0.3, respectively). Conclusions Results from this study support the use of a levofloxacin-based regimen as a first-line therapy in the treatment of H. pylori infection for 14 days regardless of diabetes and EGD findings.

Helicobacter pylori Culture and Anti-biogram: Low Yield and Beneficial Results

“…This observational study was carried out on 100 consecutive patients who presented to the endoscopy unit for upper endoscopy. In the present study, 22 patients were males and 78 were females, this gender distribution was consistent with Azab et al (16) and Peña-Galo et al (17) where (16) and Elantouny et al (15) . But in another study like Khoder et al (18) documented 25% infection between 2 and 5 years and 31% infection between 6 and 30 years.…”

“…Most of our studied patients were married (16) who reported that the commonest endoscopic abnormalities were detected in the gastric mucosa in the form of gastritis, nodular gastritis, erosions, or ulcerations.…”

Preparation and In Vitro Evaluation of Levofloxacin-Loaded Floating Tables Using Various Rate-Controlling Agents

“…These results are listed in Table . These findings confirm those of Somasundaram and Azab et al, , who found that the drug release profiles of the test tablets did not match those of the reference tablets when applied to f 1 and f 2 . One-way analysis was also applied for comparison of test tablet dissolution profiles, and P -values were found to be greater than 0.05, indicating differences in dissolution profiles.…”

Helicobacter pylori eradication rates using clarithromycin and levofloxacin-based regimens in patients with previous COVID-19 treatment: a randomized clinical trial

“…Another meta-analysis reported the global eradication rate with non-bisthmus-based triple therapy to be 81% [ 20 ]. Levofloxacin was superior to clarithromycin in a study performed in 2017 and 2018 with an eradication rate of 81% [ 21 ]. Also, this regimen achieved an eradication rate of 86% on ITT analysis and 92% on PP analysis in another study [ 22 ].…”