Levofloxacin Versus Clarithromycin Triple Therapy in First-Line Treatment for Helicobacter Pylori Eradication
Status:
Completed
Trial end date:
2009-07-01
Target enrollment:
Participant gender:
Summary
Clarithromycin-based triple therapy containing a proton-pump inhibitor (PPI) twice daily,
amoxicillin 1g twice daily, and clarithromycin 500 mg twice daily for 7 days is one of the
standard firs-line therapy for Helicobacter pylori eradication. However, because of
unsatisfactory eradication rate (80-85%), the Maastricht III guideline recommended extending
the treatment duration to increase the eradication rate. Recently, levofloxacin (500 mg
qd)-based triple therapy has been shown to achieve an eradication rate of 90% for both the
first- and second-line treatment for H. pylori eradication. Several studies have demonstrated
that high dose (750mg) and short-course (5 days) levofloxacin is as effective and well
tolerated as traditional dose (500mg) and course (10 days) for treatment of mild-to-severe
community acquired pneumonia. The high dose and short-course therapy has the potential to
increase patient compliance and reduce bacterial resistance to fluoroquinolones. However,
whether increasing the dosage of levofloxacin from 500mg to 750 mg qd can augment the
efficacy of triple therapy in eradication of H. pylori and shorten the duration of therapy
remains unknown. Although levofloxacin-based regimen was presumed to be more effective,
previous reports pointed the concern that resistance to fluoroquinolone and other antibiotics
which susceptible to the pumping efflux of bacteriae would increase among the gut flora.