Recognition of the health impact of Helicobacter Pylori (H. pylori) continues to grow, as researchers examine improved treatment regimens to effectively manage this ubiquitous pathogen. A recent meta-analysis evaluated the overall efficacy of triple therapy containing levofloxacin versus bismuth-based quadruple therapy in the management of patients with H. pylori who had failed first-line eradication therapy.

Pubmed, Cochrane Library, SPRINGER, VIP, WanFang and CKNI databases were searched for controlled trials evaluating triple therapy that incorporated levofloxacin for eradicating H. pylori; 17 publications were included in the meta-analysis.

Results indicated that triple therapy containing levofloxacin achieved a higher eradication rate (77.0%) compared to bismuth-based quadruple therapy (68.7%) although this was not statistically significant (P=0.34). This rate may differ among regions: greater eradication using levofloxacin-based triple therapy compared to bismuth quadruple regimens was reported in European compared to Asian studies, (80.6% vs 68.5%, P<0.05). The researchers noted this may relate to regional susceptibility profiles.

When eradication rates were evaluated according to the duration of treatment, it was shown that 7-days of levofloxacin-based triple therapy and bismuth-based quadruple therapy were comparable, but when increased to a longer 10 day duration of therapy, the levofloxacin-based triple therapy was significantly more effective than quadruple therapy (87.7% vs 61.3%, P<0.05). The studies in the meta-analysis included a range of levofloxacin dosages and the higher doses were not associated with greater eradication. Compliance is an integral part of ensuring optimal H.pylori treatment, and in this regard the researchers noted that the levofloxacin group was associated with significantly lower incidence of adverse events (19.1% vs 29.5%, P<0.05), compared to the quadruple therapy group. This lower rate of adverse events for levofloxacin was also associated with greater compliance (96.0% vs 89.9%, P<0.05). These features lead to the researchers to recommend the use of levofloxacin based triple therapy over bismuth-based quadruple therapy as treatment for patients who have failed first-line H.pylori eradication therapy.

PMID: 28460509

Zhonghua Nei Ke Za Zhi. 2017 May 1;56(5):368-374. doi: 10.3760/cma.j.issn.0578-1426.2017.05.013.[Article in Chinese]

https://www.ncbi.nlm.nih.gov/pubmed/28460509?dopt=Abstract