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Clinical trial: clarithromycin vs. levofloxacin in first‐line triple and sequential regimens for Helicobacter pylori eradication

2010; Wiley; Volume: 31; Issue: 10 Linguagem: Inglês

10.1111/j.1365-2036.2010.04274.x

1365-2036

Javier Molina‐Infante, Belén Pérez-Gallardo, Miguel Fernández‐Bermejo, Moisés Hernández-Alonso, Gemma Vinagre, Carmen Dueñas, José María Mateos-Rodríguez, Guadalupe Gonzalez‐Garcia, Elena Garcia Abadia, Javier P. Gisbert,

Gastric Cancer Management and Outcomes

Helicobacter pylori eradication rates with standard triple therapy have declined to unacceptable levels.To compare clarithromycin and levofloxacin in triple and sequential first-line regimens.A total of 460 patients were randomized into four 10-day therapeutic schemes (115 patients per group): (i) standard OCA, omeprazole, clarithromycin and amoxicillin; (ii) triple OLA, omeprazole, levofloxacin and amoxicillin; (iii) sequential OACM, omeprazole plus amoxicillin for 5 days, followed by omeprazole plus clarithromycin plus metronidazole for 5 days; and (iv) modified sequential OALM, using levofloxacin instead of clarithromycin. Eradication was confirmed by 13C-urea breath test. Adverse effects and compliance were assessed by a questionnaire.Per protocol cure rates were: OCA (66%; 95% CI: 57-74%), OLA (82.6%; 75-89%), OACM (80.8%; 73-88%) and OALM (85.2%; 78-91%). Intention-to-treat cure rates were: OCA (64%; 55-73%), OLA (80.8%; 73-88%), OACM (76.5%; 69-85%) and OALM (82.5%; 75-89%). Eradication rates were lower with OCA than with all the other regimens (P < 0.05). No differences in compliance or adverse effects were demonstrated among treatments.Levofloxacin-based and sequential therapy are superior to standard triple scheme as first-line regimens in a setting with high clarithromycin resistance. However, all of these therapies still have a 20% failure rate.