Triple eradication regimen containing levofloxacin vs quadrotherapy using bismuth preparations for persistent infection with Helicobacter pylori : results of the meta-analysis

The triple eradication regimen containing levofloxacin is considered an alternative to quadrotherapy using bismuth preparations for persistent infection with Helicobacter pylori.

In a systematic review undertaken by R.J. Saad et al. (USA), searched the PUBMED, EMBASE and EBM Review databases, as well as summaries of recent gastro conferences -enterological "Digestive Disease" Week ", " United European Week of Gastroenterology " and the conferences of the European Study Group Helicobacter Helicobacter The meta-analysis included data from randomized controlled trials that compared the course of triple therapy based on levofloxacin (levofloxacin + amoxicillin + proton pump inhibitor) with the course of quadrotherapy using bismuth preparations ( bismuth + tetracycline + metronidazole + proton pump inhibitor). Data from all prospective studies were subjected to additional analysis, during which the study of triple therapy with levofloxacin was conducted to determine the optimal duration of treatment and dose of the drug In all selected studies, the ineffectiveness of the previous eradication therapy was confirmed.

In 4 randomized controlled clinical trials, a 10-day triple therapy regimen was compared to a 7-day quadrotherapy regimen (n = 391 patients) meeting the above criteria. According to the results obtained, the course of triple therapy with levofloxacin has shown a greater efficacy than that of quadrotherapy using bismuth preparations (relative risk (RR) 1.41; 95% confidence interval (CI) 1 , 25-1.59). Triple therapy was better tolerated than quadrotherapy and was accompanied by fewer adverse effects both in general (RR 0.51; 95% CI 0.34-0.75) and requiring discontinuation of treatment (RR 0, 3; 95% CI 0.1-0.89).

A complete analysis of 11 studies evaluating triple therapy with levofloxacin (n = 547 patients) showed a higher eradication rate during a 10-day treatment compared to a 7-day treatment (87%; CI 95% 82-92% vs ( 68% 95% CI 62-74%). At the same time, in the analysis of 8 studies (n = 477 patients), there were no difference in the effectiveness of treatment regimens using 500 mg of levofloxacin per day and 250 mg twice daily (81% 95% CI 78-89% vs 84% 95% CI 66-97% ).

Thus, a 10-day course of triple therapy based on levofloxacin was more effective and tolerable than a 7-day course of quadrotherapy based on bismuth with persistent infection by H. pylori.