<p>Reevaluation of the Efficacy of First Line Regimen for <em>Helicobacter pylori</em></p>

Abstract

Background: Helicobacter pylori is a common cause of gastritis, peptic ulcer disease, and non-ulcer dyspepsia, and is also associated with gastric adenocarcinoma and mucosa associated lymphoid tissue lymphoma. Despite being known about for more than 30 years, finding an effective therapeutic strategy against it remains a challenge. Aim: There are no US studies evaluating the efficacy of a Levofloxacin based therapy for H. pylori infection. We here intend to study the efficacy of Levofloxacin based triple antibiotic regimen as compared to Clarithromycin based triple therapy and Bismuth based quadruple therapy in our patient population. Methods: This is a retrospective single center observational study. Patients with Helicobacter pylori infection who underwent treatment for H. pylori with one of the three therapies, i.e. Clarithromycin triple, Bismuth Quadruple or Levofloxacin triple, were included in the study and the eradication rates were compared. The confirmation of the H. pylori was done 4 weeks after the completion of anti-microbial therapy. Results: A total of 177 individuals underwent the H. pylori treatment in our retrospective review. Of these, 54% (n=97) of patients were treated with Clarithromycin based triple therapy (Group 1), 35% (n=63) were treated with Levofloxacin based regimen (Group 2), and the remaining 11% (n=17) were treated with Bismuth based quadruple therapy (Group 3). The eradication rates were significantly higher in patients treated with Clarithromycin based triple therapy as compared to Levofloxacin based triple therapy and Bismuth quadruple therapy (78.3% vs 49.2% vs 41.1% P=0.001). Conclusion: In conclusion, our study shows significantly lower eradication rates with Levofloxacin triple therapy among a selected US population. Thus, it may not be a good first-line therapy among this US population and the Clarithromycin based regimen may still be used successfully.

The Activity of Liposomal Linolenic Acid Against Helicobacter pylori In Vitro and Its Impact on Human Fecal Bacteria

“…H. pylori infection remains a difficult challenge worldwide, especially in some developing countries ( Hooi et al., 2017 ). Antibiotic regimens have been modified continuously to overcome drug resistance, but the results remain unsatisfactory ( Song et al., 2016 ; Tariq et al., 2020 ). Obviously, the discovery of an effective H. pylori eradication therapy would have global significance.…”

The status and progress of first-line treatment against Helicobacter pylori infection: a review

“… 6 However, in a retrospective observational study carried out in the USA comparing the eradication rate between the three first-line regimens, the eradication rate of levofloxacin-based triple therapy was considerably lower (49.2%) than that of clarithromycin-based triple therapy (78.3%). 21 The difference in effectiveness may be due to differences in drug resistance for adults in different regions, with levofloxacin resistance rates of 14.1% in Europe (Western/Central and Southern Europe >20%; Northern European countries <10%), and 31.3% in North America. 22 , 23 Therefore, it is particularly important to establish a regional drug resistance database as soon as possible.…”

Review – Treatment of Helicobacter pylori infection 2020

“…Triple therapy (TT) remains the standard of care in the published international guidelines of the European Helicobacter and Microbiota Study Group (EHMSG) in areas of low clarithromycin resistance 4 . Two studies from the Americas looked at the outcomes and both showed poor eradication rates albeit with divergent results for TT with clarithromycin compared to levofloxacin 5,6 . In the US, 78% of patients receiving clarithromycin‐based TT achieved eradication, compared to 49% with levofloxacin‐based TT 5 .…”

“…Two studies from the Americas looked at the outcomes and both showed poor eradication rates albeit with divergent results for TT with clarithromycin compared to levofloxacin 5,6 . In the US, 78% of patients receiving clarithromycin‐based TT achieved eradication, compared to 49% with levofloxacin‐based TT 5 . On the other hand, in Argentina 75% of patients were cured with clarithromycin TT but 93% achieved eradication with levofloxacin TT 6 .…”