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For H. pylori management, Levofloxacin + Tetracycline is more effective than Clarithromycin + Amoxicillin.
Although having a higher rate of complications, the combination of Tetracycline and Levofloxacin is more effective for eliminating Helicobacter pylori (H. pylori) than Clarithromycin and Amoxicillin, according to the findings of a recent multicenter, multinational randomized controlled trial. The purpose of the investigators was to assess the effectiveness of Tetracycline with Levofloxacin in the treatment of H. pylori infection.
All H. pylori-infected subjects were recruited and randomly assigned to receive either Tetracycline with Levofloxacin (Group A) or Clarithromycin with Amoxicillin (Group B) quadruple regimen for 2 weeks throughout six months in 8 referral tertiary centres of 3 different countries. All the volunteers continued Pantoprazole for a further 4 weeks, and then, one to two weeks after stopping the medication, a 13C urea breath test was completed by them to demonstrate complete elimination.
A total of 788 volunteers were incorporated, with 358 men (average age of 44.2 years). Peptic ulcer disease (234 instances, 29.69%), intestinal metaplasia (38 instances, 4.8%), and non-ulcer dyspepsia (516 instances, 65.5%) were the diagnoses made in these patients. Overall, 63.1% of the population was identified as Caucasian, 14.5% as Arab, 15.6% as African, and 6.1% as Asian.
Individuals were divided into groups A and B at random and given either Clarithromycin or Tetracycline plus Levofloxacin. In intention-to-treat and per-protocol analyses, the percentage of participants in groups A and B that achieved eradication were 75.2% and 82.1% (285 cases) and 67.5% and 70.1% (276 instances), respectively. Groups A and B had complete compliance rates of 84.4% and 83.6%, respectively.
During the trial, 33.5% of group A subjects (127 instances) reported side effects. In group B, the complication rate was found to be 27.9% (114 cases). Nausea and vomiting (12.6% and 9.3%) and stomach discomfort (4.48% and 2.68%) were the most frequently reported symptoms in groups A and B, respectively. In groups A and B, the rates of severe complications that led to drug cessation were 2.1% and 1.46%, respectively.
In subgroup analysis, the elimination rates of Tetracycline plus Levofloxacin were 79.4%, 88.1%, and 73.9% among patients with non-ulcer dyspepsia, peptic ulcer disease, and intestinal metaplasia, respectively. These percentages were 71.3%, 67.6%, and 61.5% in group B. Hence, the treatment plan of Levofloxacin+Tetracycline quadruple regimen may be the ideal option for eliminating H. pylori in regions with high levels of Clarithromycin resistance, especially in those with peptic ulcer disease.
Middle East Journal of Digestive Diseases
Levofloxacin+Tetracycline Quadruple Regimen for Eradication of Helicobacter Pylori: a Multicenter Multinational Randomized Controlled Trial
Pezhman Alavinejad et al.
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