Levofloxacin-based triple therapy has been suggested as an alternative salvage therapy to bismuth-based quadruple therapy for persistent Helicobacter pylori infection.
Dr William Chey and colleagues searched PUBMED, EMBASE, and EBM Review databases.
The research team searched abstracts from Digestive Disease Week, United European Gastroenterology Week, and European Helicobacter Study Group conferences.
The team included randomized controlled trials comparing levofloxacin-based triple salvage therapy to bismuth-based quadruple salvage therapy.
All prospective trials evaluating this levofloxacin-based triple therapy as salvage therapy were pooled.
The researchers analyzed optimal levofloxacin treatment duration and dosing.
|Levofloxacin-based triple therapy had higher eradication rates with a 10-day regimen|
|American Journal of Gastroenterology|
All selected trials confirmed prior treatment failure and post-salvage treatment eradication.
The team compared 4 trials including 391 patients comparing a 10-day regimen of levofloxacin-based triple therapy to 7-day bismuth-based quadruple therapy.
Levofloxacin-based triple therapy was superior to quadruple therapy.
The team found that levofloxacin-based triple therapy was better tolerated than quadruple therapy with a lower incidence of side effects.
Levofloxacin-based triple therapy trials also showed lower side effects prompting discontinuation of therapy.
The team found that 11 trials with 547 patients evaluating levofloxacin-based triple therapy had higher eradication rates with 10-day vs 7-day regimen.
However, 8 trials with 477 patients demonstrated no difference with 500 mg daily versus 250 mg b.i.d. dosing of levofloxacin.
Dr Chey's team concluded, “A 10-day course levofloxacin triple therapy is more effective and better tolerated than 7-day bismuth-based quadruple therapy in the treatment of persistent H pylori infection.”