Levofloxacin-based Helicobacter pylori eradication in chronic dyspepsia

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.