Observation Of The Effect Of Five-day And Seven-day Triple Therapy With Levofloxacin For Helicobacter Pylori Infection

Objective:To compare the effect of 5-day and 7-day regimens of esomeprazole,levofloxacin and furazolidone triple therapy(ELF)with 7-day esomeprazole,amoxicillin and clarithromycin triple therapy(EAC) for the eradication of helicobacter pylori infection.The aim is to find an effective and practical short-term therapeutic therapy for patients with Helicobacter pylori infection.Method:167 consecutive H.pylori positive patients with peptic ulcer or chronic gastritis were selected and randomly divided into three groups: (â…°)5dELF group(35 patients with peptic ulcer and 20 patients with chronic gastritis):treated with esomeprazole 20 mg,levofloxacin 0.2 g, and furazolidone 0.1 g,all twice daily for 5 days;(â…±)7dELF group(35 patients with peptic ulcer and 21 patients with chronic gastritis):treated with the same drugs and dosage with 5dELF group,twice daily for 7 days; or(â…²)7dEAC group(35 patients with peptic ulcer and 21 patients with chronic gastritis):treated with esomeprazole 20 mg,amoxicillin 1000 mg and clarithromycin 500 mg,all twice daily for 7 days.The patients with chronic gastritis in three groups discontinued all drugs after the course of treatment,while the patients with peptic ulcer continued to receive esomeprazole(20 mg,once day)for another 2～4 weeks after being stopped antibiotics.After completion of H.pylori therapy at least four weeks later and after withdrawal of PPI at least two weeks later,we compared the H.pylori status,ulcer healing,clinical symptoms and side-effects among three groups by inquire,endoscopy and a ¹⁴C-urea breath test(¹⁴C-UBT). Three regimens were evaluated by cost effectiveness analysis and facters affecting the rate of H.pylori eradication were filtered by logistic regression analysis.Results:145 patients complete the whole therapy,22 patients failed to return for follow-up.1.The rates of H.pylori eradication in 5dELF group,7dELF group and 7dEAC group were 63.64%,71.43%and 73.21%respectively by intention to treat analysis and were 76.09%,80.00%and 83.67% respectively by per protocol analysis(the differences had no statistical significance,P>0.05).2.The peptic ulcer healing rates,the clinical symptom remission rates and the incidence of adverse reactions were not different significantly(P>0.05).3.The cost effectiveness analysis showed that the cost and C/E value of both 5-day ELF regimen and 7-day ELF regimen were lower than 7-day EAC regimen.4.Multiple regression analysis identified that there were correlations between age,the history of peptic ulcer,endoscopic finding and ¹⁴C-UBT intension before treatment and H.pylori therapeutic outcome, but no correlations between sex,body mass index(BMI),smoking and drinking habit and H.pylori therapeutic outcome were found.Overall eradication was higher in older patients(≥45 years)with peptic ulcer and lower value of ¹⁴C-UBT,but without a history of PU.5.The rate of H.pylori eradication of patients with peptic ulcer was higher than that of patients with chronic gastritis in both 5dELF regimen and 7dEAC regimen(P<0.05),but no significant difference was found in 7dELF regimen(P>0.05).Conclusion:1.Both 5-day and 7-day ELF triple therapy are effective therapeutic regimens for Helicobacter pylori infection with the advantages of excellent compliance of patients,mild side-effects,lower cost and superior ratio of effectiveness to price.They can be recommended as first-line therapy regimens of eradicating H.pylori in undeveloped region,especially for the patients with peptic ulcer.2.The rate of H.pylori eradication is higher in older patients(≥45 years) without a history of PU and with lower value of ¹⁴C-UBT before primary treatment.The rate of H.pylori eradication of patients with peptic ulcer was higher than that of patients with chronic gastritis.