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Reevaluation of the Efficacy of First Line Regimen for Helicobacter pylori

Authors Tariq H, Patel H, Kamal MU, Abbas N, Ameen M, Azam S, Kumar K, Ravi M, Vootla V, Shaikh D, Amanchi V, Hussain AN, Makker J

Received 20 November 2019

Accepted for publication 7 January 2020

Published 22 January 2020 Volume 2020:13 Pages 25—33


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 4

Editor who approved publication: Prof. Dr. Wing-Kin Syn

Hassan Tariq, 1, 2 Harish Patel, 1, 2 Muhammad Umar Kamal, 1 Naeem Abbas, 1, 2 Muhammad Ameen, 1 Sara Azam, 1 Kishore Kumar, 1, 2 Madhavi Ravi, 1, 2 Vamshidhar Vootla, 1, 2 Danial Shaikh, 1, 2 Vamsi Amanchi, 1 Ali N Hussain, 3 Jasbir Makker 1, 2

1Department of Medicine, BronxCare Health System, Bronx, NY 10457, USA; 2Division of Gastroenterology, BronxCare Health System, Bronx, NY 10457, USA; 3Baruch College, City University of New York (CUNY), New York, NY 10010, USA

Correspondence: Muhammad Umar Kamal
BronxCare Health System, 1650 Selwyn Ave, Suite #10C, Bronx, NY 10457, USA
Tel +1 718-960-1234
Fax +1 718-960-2055

Background: Helicobacter pylori is a common cause of gastritis, peptic ulcer disease, and non-ulcer dyspepsia, and is also associated with gastric adenocarcinoma and mucosa associated lymphoid tissue lymphoma. Despite being known about for more than 30 years, finding an effective therapeutic strategy against it remains a challenge.
Aim: There are no US studies evaluating the efficacy of a Levofloxacin based therapy for H. pylori infection. We here intend to study the efficacy of Levofloxacin based triple antibiotic regimen as compared to Clarithromycin based triple therapy and Bismuth based quadruple therapy in our patient population.
Methods: This is a retrospective single center observational study. Patients with Helicobacter pylori infection who underwent treatment for H. pylori with one of the three therapies, i.e. Clarithromycin triple, Bismuth Quadruple or Levofloxacin triple, were included in the study and the eradication rates were compared. The confirmation of the H. pylori was done 4 weeks after the completion of anti-microbial therapy.
Results: A total of 177 individuals underwent the H. pylori treatment in our retrospective review. Of these, 54% (n=97) of patients were treated with Clarithromycin based triple therapy (Group 1), 35% (n=63) were treated with Levofloxacin based regimen (Group 2), and the remaining 11% (n=17) were treated with Bismuth based quadruple therapy (Group 3). The eradication rates were significantly higher in patients treated with Clarithromycin based triple therapy as compared to Levofloxacin based triple therapy and Bismuth quadruple therapy (78.3% vs 49.2% vs 41.1% P=0.001).
Conclusion: In conclusion, our study shows significantly lower eradication rates with Levofloxacin triple therapy among a selected US population. Thus, it may not be a good first-line therapy among this US population and the Clarithromycin based regimen may still be used successfully.

Keywords: Helicobacter pylori, clarithromycin, levofloxacin, quadruple therapy, peptic ulcer

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