Pilot study: Comparing efficacy of 14-day triple therapy Clarithromycin versus levofloxacin on eradication of Helicobacter Pylori infection in Syrian population single-center experience

Abstract

Context:Goals: To compare the efficacy of standard triple therapy with clarithromycin versus triple therapy with levofloxacin for treatment of Helicobacter pylori-positive infection in a referral hospital in Damascus, Syria.Design:pilot prospective open-label randomized controlled trial.Subjects and Methods:Eighty treatment-naive patients who tested positive for H. pylori gastric infection were randomly assigned to one of two treatment groups with randomization ratio of 50/50. Group (A) was treated with clarithromycin (500 mg), amoxicillin (1000 mg), and esomeprazole (20 mg), each twice/day for 14 days, while Group (B) was treated with levofloxacin (500 mg), amoxicillin (1000 mg), and esomeprazole (20 mg), each twice/day for 14 days.[1] After 6 weeks of treatment, all patients underwent endoscopy and biopsy to evaluate H. pylori infection eradication.Results:Forty patients were allocated in each group; 37 patients completed the follow-up in each group. Thirteen patients in Group (A) were cured, with an eradication rate of 35.1% according to per-protocol analysis (PPA) and 32.5% according to intention-to-treat analysis (ITT), while in Group (B), 11 patients were cured, with an eradication rate of 29.7% according to PPA and 27.5% according to ITT with P = 0.80. No serious adverse events reported in both the groups.Conclusions:Clarithromycin is slightly better than levofloxacin in treatment of H. pylori gastric infection, but both regimens show low effectiveness with suboptimal eradication rates in our selected population.

High primary resistance to metronidazole and levofloxacin, and a moderate resistance to clarithromycin in Helicobacter pylori isolated from Karnataka patients

“…Helicobacter pylori is a gastric pathogen that colonises human stomach, leading to clinical manifestations of chronic gastritis, peptic ulcer disease, gastric adenocarcinoma and mucosa associated lymphoid tissue (MALT) lymphoma [1]. Current standard H. pylori eradication regime, also known as triple therapy, comprises two antibiotics (amoxicillin and clarithromycin or metronidazole) and a proton pump inhibitor (PPI) [5]. However, due to surging prevalence of clarithromycin and metronidazole resistance in H. pylori , the treatment success rate of either clarithromycin-based or metronidazole-based triple therapy is merely 80% or less in certain global regions [2–6].…”

Efficacy of two-week therapy with doxycycline-based quadruple regimen versus levofloxacin concomitant regimen for helicobacter pylori infection: a prospective single-center randomized controlled trial

“…The result of levofloxacin containing therapy can be regarded as Grade D standard, while the result of bismuth-containing therapy can be regarded as Grade F as proposed recently [ 32 ]. The former results are better than our preceding study outcomes regarding the treatment of H. pylori [ 14 ]. Our results are agreeing with a meta-analysis by Essa et al and similar research by Federico et al Both studies showed that concomitant therapy is effective in the eradication of H.Pylori [ 26 , 33 ].…”

“…Researchers globally observe a decline in the rate of H pylori eradication following standard triple therapies, thus requiring a search for new therapeutic approaches [45–48]. This randomized clinical trial included 78 patients from an area of high prevalence (>15%) of clarithromycin and levofloxacin resistant helicobacter pylori strains [ 1 , 12 , 14 , 30 , 31 ]. Both concomitant and bismuth-containing quadruple therapies are recommended as alternative first-line treatment according to the previously mentioned guidelines, particularly in regions with a high prevalence of clarithromycin resistance [ 13 , 15 ].…”

“…Several researchers reviewed many therapeutic regimens including sequential, concomitant, and hybrid to find the best treatment protocol [ 13 ]. The results of conventional triple therapy in Syria were disappointing [ 14 ]. Currently tetracycline is unavailable in Syria, so we used doxycycline in the bismuth quadruple regimen [ 15 , 16 ].…”

Advanced diffuse gastric adenocarcinoma in young Syrian woman. A case report

“…Other risk factors are genetic and family history of cancers such as hereditary nonpolyposis colorectal cancer (Lynch syndromes I & II) and familial adenomatous polyposis (FAP) [ 7 ], and none of them appear to be true in our case based on the history. Helicobacter Pylori infection is the most potently recognized risk factor for gastric adenocarcinoma; however, even after decades of infection, the only an insignificant proportion of infected subjects develop adenocarcinoma [ 8 ], and there is insufficient evidence to suggest the optimal age to begin eradication therapy [ 9 , 10 ], knowing that Helicobacter pylori infection eradication is difficult in Syria [ 11 , 12 ]. Early detection of a gastric tumor is critical in determining prognosis, and each of the following indicates metastatic gastric cancer: weight loss, anemia, Virchow nodes (left supraclavicular), Irish node (anterior axillary), and periumbilical (Sister Mary Joseph nodule).…”