Levofloxacin-Based Regimen Versus Bismuth Quadruple Regimen for Helicobacter pylori Eradication in Kurdistan Region, Iraq

Background: Helicobacter pylori infection is associated with peptic ulcer diseases and gastric adenocarcinoma. Accordingly, the aim of this study was to assess the efficiency of tetracycline quadruple therapy versus levofloxacin-based regimen (LBR) for the eradication of H. pylori. Methods: To this end, 197 subjects with H. pylori infection were recruited in this randomized clinical study in Kurdistan region, Iraq between October 2018 and May 2019 and randomly divided into 2 groups. The LBR group received levofloxacin 500 mg one time per day, amoxicillin 1000 mg two times per day, and omeprazole 20 mg two times per day for two weeks. In addition, the tetracycline-metronidazole-bismuth (TMB) group received bismuth subcitrate 140 mg, metronidazole 125 mg, and tetracycline 125 mg plus omeprazole 20 mg twice per day for 10 days. Finally, 28 days after the completion of the treatment course, the eradication of H. pylori was evaluated by the 14C urease breath test. Results: The total eradication rate of H. pylori infection was 149/197 (75.6%). Although the success eradication rate in the LBR regimen was 70/112 (62.5%), the eradication success rate was 79/85 (92.9%) in the TMB regimen (P = 0.001, odds ratio = 7.9, confidence interval = 3.17-19.7). Finally, gender and age represented on the effect of the eradication rate. Conclusions: In general, the bismuth-based regimen could eradicate a high rate of H. pylori infection. Therefore, this regimen can be used to overcome treatment failure in areas with a high prevalence of antibiotics resistance.