Antofloxacin was found to be an effective and safe agent for eliminating H. pylori. Antofloxacin-based bismuth quadruple therapy may be used as an alternative therapy for eradicating H. pylori.

A randomized, prospective, single-center, open-label trial was carried to evaluate the safety, efficacy, and tolerability of antofloxacin-based and levofloxacin-based bismuth quadruple therapy in 290 Chinese patients suffering from H. pylori infection.

Subjects were allocated into two arms as per different bismuth quadruple therapies for 14 days colloidal bismuth pectin (200 mg thrice a day), lansoprazole (30 mg twice a day), amoxicillin (1 g twice a day), and antofloxacin (200 mg once a day) [ACLA group, n=145] or levofloxacin (500 mg once a day) [LCLA group, n=145].

With the aid of the 13C-urea breath test six weeks after therapy completion, H. pylori elimination was examined. The H. pylori elimination rate by intention-to-treat and per-protocol assessment was the major outcome. To investigate the susceptibility of H. pylori strains on gastric biopsy specimens to levofloxacin and antofloxacin, the minimum inhibitory concentration was estimated using PDM epsilometer test.

The H. pylori elimination rates in the ACLA group were considerably greater compared to the LCLA group, as shown below:

The total incidence of adverse events during H. pylori elimination did not considerably differ between the two groups. Both the groups demonstrated a comparable severity of adverse events and compliance rate.

The elimination rate with the antofloxacin susceptible strains in the ACLA arm was remarkably greater compared to the resistant strains. Furthermore, the elimination rate with the levofloxacin susceptible strains in the LCLA arm was considerably greater compared to the resistant strains, as shown in the table below:

Antofloxacin is effective to eliminate H. pylori infection as a component of bismuth quadruple treatment.