Efficacy Of First-line And Rescue Therapy For Helicobacter Pylori Infection

Objective:To compare the efficacy of low dose clarithromycin-based triple regimen with regular dose clarithromycin-based triple regimen for eradication of H.pylori.To test the efficacy and safety of the 7-day levofloxacin(Cravit)- based quadruple therapy for the rescue regimen of Helicobacter pylori infection.The aim of the study was to discuss safe and effective therapies for Helicobacter pylori infection.Methods:A total of 115 patients who were confirmed to be chronic gastritis or peptic ulcer infected H.pylori were randomized into one of two regimens:(â…°)esomeprazole 20 mg b.i.d.,amoxicillin 1 g b.i.d and clarithromycin 250 mg b.i.d(low dose group)for 7 days;(â…±) esomeprazole 20 mg b.i.d.,amoxicillin 1 g b.i.d and clarithromycin500 mg b.i.d(regular dose group)for 7 days.UBT was repeated for at least 4 weeks after treatment,and at least 2 weeks after taking PPIs.Forty-one patients who had H.pylori eradication one or more times with chronic gastritis or peptic ulcer,but recent ¹⁴C -Urea breath test(UBT)was still positive,were treated with the regimen:levofloxacin(Cravit,500 mg q.d.),furazolidone(100 mg b.i.d.),bismuth potassium citrate(220mg b.i.d.),and lansoprazole(Takepron,30 mg b.i.d.)for 7 days,The eradication rates,efficacy,and side-effect rates of the three regimens were observed. Results.1.102 patients completed the protocols.The 'intention-to-treat' (ITT)and 'per protocol'(PP)H.pylori eradication rates were 71.19%and 79.24%in the low dose group,and 73.21%and 83.67%in the regular dose group.The low dose treatment achieved a similar eradication rate compared with the regular treatment in PP analysis (79.24%vs.83.67%,P=0.566).The eradication rates of patients with peptic ulcer in the two groups were similar(90.91%vs.93.55%, P=1.000),that is the same happened in patients with chronic gastritis(60.00%vs.66.67%,P=0.671),but peptic ulcer's patients have much higher eradication rates compared with chronic gastritis' patients in both groups(P=0.019 and 0.040,respectively).The total release rate of all symptoms,the completely healing rates of ulcers and side effects were similar in the two groups in PP analysis.2.Eradication rates by intention-to-treat and per-protocol analyses were 78.0%(95%CI 65.3-90.7%)and 86.5%(95%CI 75.5-97.5%),respectively. The total release rate of all symptoms was 91.9%.Gastroscopy was repeated for at least 4 weeks after treatment,the completely healing rate was 80%(95%CI 28%-99%),and the effective rate was 100%. Side-effects were slight and the side-effects rate was 16.2%.Conclusions:1.The low dose group achieved similar efficacy compared with the regular dose group.2.The levofloxacin-based quadruple rescue therapy was effective, the eradication rate was 86.5%,and the side effects were few and mild.