Volume 24, Issue 104, July - August, 2020

Bismuth quadruple therapy versus levofloxacin triple therapy for first-line helicobacter pylori eradication treatment: multicenter study

Tran Thi Khanh Tuong¹, Huynh Quang Huy^1♦, Tong Nguyen Diem Hong², Nguyen Thi Anh Đao², Ngo Thi Thanh Quyt³

¹Pham Ngoc Thach University of Medicine, Ho Chi Minh city, Vietnam
²Dai Phuoc General Clinic, Ho Chi Minh City, Vietnam
³Thong Nhat Hospital, Ho Chi Minh City, Vietnam

^♦Corresponding author
Department of Radiology, Pham Ngoc Thach Medical University, Vietnam; Email: huyhq@pnt.edu.vn

ABSTRACT

Background: Bismuth-containing quadruple regimen and levofloxacin-based triple therapy are recommended as first-line therapy in areas with high clarithromycin and metronidazole resistance. However, increasing resistance to levofloxacin in Vietnam can affect the success rate of levofloxacin-based triple therapy. There have been few studies comparing the efficacy of bismuth-based quadruple therapy with levofloxacin-based triple therapy for the first-line treatment of H. pylori infection in our country. Patients and Methods: We included 658 patients with H.pylori infection. However, there were 167 patients lost to follow-up. Four hundred ninety-one patients were randomly assigned either to the bismuth-containing quadruple regimen (Group RBMT, N=252) or to levofloxacin triple (Group RAL, N=239). Both groups treated for 14 days. Eradication of H. pylori was assessed by 13C- urea breath test or Closet 4-8 weeks after therapy. Results: The H. pylori eradication rates of Group RBMT and Group RAL on the intention to treat analysis (ITT) were 84.1% in Group RBMT and 77.4% in Group RAL (P<0.05). The per-protocol eradication rates were 95.9% and 80.1%, respectively (p<0.05). Side effects were significantly higher in the Group RBMT 73.3% than Group RAL 36.4% (p<0.05). The compliance rate of more than 90% of Group RBMT and Group RAL were 78.6% and 88.3% (p<0.05), respectively. Conclusions: A 14-day course of levofloxacin triple therapy appeared to be more productive and better tolerated than a 10-day bismuth-based quadruple therapy in the treatment of persistent H. pylori infection. However, the bismuth-containing quadruple regimen had more adverse effects and lower medication adherence than that of levofloxacin-based triple therapy.

Keywords: Bismuth-containing quadruple regimen, levofloxacin-based triple therapy, Helicobacter pylori infection

Medical Science, 2020, 24(104), 2245-2250

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