Clinical trial: levofloxacin‐based quadruple therapy was inferior to traditional quadruple therapy in the treatment of resistant Helicobacter pylori infection

Summary Background  The efficacy of levofloxacin-based quadruple therapy in resistant Helicobacter pylori infection is not known. Aim  To test the efficacy of levofloxacin-based quadruple therapy and traditional quadruple therapy in resistant H. pylori infection. Methods  One hundred and two patients with resistant H. pylori infection were randomized to 1 week of either EBAL (esomeprazole 40 mg b.d., bismuth subcitrate 240 mg b.d., amoxicillin 1 g b.d. and levofloxacin 500 mg b.d.) or EBMT (esomeprazole 40 mg b.d., bismuth subcitrate 240 mg b.d., metronidazole 400 mg t.d.s. and tetracycline 500 mg q.d.s.). 13C-urea breath test was performed at week 12 to assess post-treatment H. pylori status. Results  In intention-to-treat analysis H. pylori eradication was achieved in 37 of 51 (73%) subjects in EBAL and 45 of 51 (88%) subjects in EBMT groups, respectively (P = 0.046). Per-protocol eradication rates of EBAL and EMBT groups were 78% and 94%, respectively (P = 0.030). The intention-to-treat eradication rate was statistically lower for EBAL than EMBT (56% vs. 90%, P = 0.013) among those who had failed more than one course of eradication therapy. Previous levofloxacin triple therapy did not affect the efficacy of either protocol significantly. Conclusions  Levofloxacin-based quadruple therapy was inferior to traditional quadruple therapy for resistant H. pylori infection.