Levofloxacin-based triple therapy versus bismuth-based quadruple therapy for persistent Helicobacter pylori infection : A meta-analysis

• Published in: The American journal of gastroenterology Vol. 101; no. 3; pp. 488 - 496
• Main Authors: SAAD, Richard J, SCHOENFELD, Philip, HYUNGJIN MYRA KIM, CHEY, William D
• Format: Journal Article
• Language: English
• Published: Oxford Blackwell Publishing 01.03.2006; Wolters Kluwer Health Medical Research, Lippincott Williams & Wilkins
• Subjects: Amoxicillin; Amoxicillin - therapeutic use; Anti-Ulcer Agents - therapeutic use; Antibacterial agents; Antibiotics. Antiinfectious agents. Antiparasitic agents; Bacterial diseases; Bacterial diseases of the digestive system and abdomen; Biological and medical sciences; Bismuth - therapeutic use; Drug Resistance, Bacterial; Drug Therapy, Combination; Gastritis - drug therapy; Gastroenterology; Gastroenterology. Liver. Pancreas. Abdomen; Helicobacter Infections - drug therapy; Helicobacter pylori; Human bacterial diseases; Humans; Infectious diseases; Levofloxacin; Medical sciences; Metronidazole - therapeutic use; Ofloxacin - therapeutic use; Pharmacology. Drug treatments; Proton Pump Inhibitors; Randomized Controlled Trials as Topic; Tetracycline - therapeutic use; Levofloxacin; Spirillales; Spirillaceae; Infection; Fluoroquinolone derivatives; Treatment; Helicobacter pylori; Gastroenterology; Bismuth; Bacteria; Antibacterial agent; Quinolone derivatives; Comparative study
• ISSN: 0002-9270; 1572-0241
• DOI: 10.1111/j.1572-0241.2006.00637.x

Levofloxacin-based triple therapy has been suggested as an alternative salvage therapy to bismuth-based quadruple therapy for persistent Helicobacter pylori (H. pylori) infection. A search of PUBMED, EMBASE, EBM Review databases and abstracts from recent Digestive Disease Week, United European Gastroenterology Week, and European Helicobacter Study Group conferences was performed. Randomized controlled trials (RCTs) comparing levofloxacin-based triple salvage therapy (levofloxacin + amoxicillin + PPI) to bismuth-based quadruple salvage therapy (bismuth + tetracycline + metronidazole + PPI) were selected for meta-analysis. Additionally, all prospective trials evaluating this levofloxacin-based triple therapy as salvage therapy were pooled to analyze optimal levofloxacin treatment duration and dosing. All selected trials confirmed prior treatment failure and post-salvage treatment eradication. Four RCTs compared a 10-day regimen of levofloxacin-based triple therapy to 7-day bismuth-based quadruple therapy (n = 391 patients). Levofloxacin-based triple therapy was superior to quadruple therapy (RR = 1.41 [95% CI: 1.25-1.59]). Levofloxacin-based triple therapy was better tolerated than quadruple therapy with a lower incidence of side effects (RR = 0.51 [95% CI: 0.34-0.75]) and side effects prompting discontinuation of therapy (RR = 0.30 [95% CI: 0.10-0.89]). Eleven trials (n = 547 patients) evaluating levofloxacin-based triple therapy demonstrated higher eradication rates with 10-day versus 7-day regimen (87%[95% CI: 82%-92%]vs 68%[95% CI: 62%-74%]) yet eight trials (n = 477 patients) demonstrated no difference with 500 mg daily versus 250 mg b.i.d. dosing of levofloxacin (81%[95% CI: 78%-89%]vs 84%[95% CI: 66%-97%]). 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.