The Impact Of Different Durations Of Levolfoxacin-based Regimen And The Concentration Of The Drug On The Eradication Rate In The Initial Treatment Of Helicobacter Pylori Infection

ObjectiveTo observe the therapeutic effect of7days of leofloxacin-based triple regimen and10days of leofloxacin-based triple regimen as the initial therapy for Helicobacter pylori infection and the impact of the concentration of levofloxacin in the gastric mucosa on the eradication rate of H. pylori.Methods:240patients with H. pylori infection suffering from chronic gastritis were randomly divided into7days of levofloxacin-based triple regime group (n=120) and10days of levofloxacin-based triple regime group (n=120).7days of levofloxacin-based triple regime group received therapy with esomeprazole20mg twice a day plus amoxicillin1000mg twice a day and levofloxacin500mg once a day, for7days;10days of levofloxacin-based triple regime group received therapy with esomeprazole20mg twice a day plus amoxicillin1000mg twice a day and levofloxacin500mg once a day, for10days. H. pylori status was rechecked by14C-urea breath test4-8weeks after the end of the therapy. Make logistic regression analysis on the factors influencing the effect of H. pylori eradication and the assessment of the two groups of patients with remission rate of clinical symptom. The patients who were informed consent to attend the study receiving gastroscopy and were drawn four mucosal tissues from the antrum on the first day after the end of therapy. The concentration of levofloxacin in the gastric mucosa was determined by high performance liquid chromatography (HPLC).Results:(1)A total of224patients completed the follow-up. The eradication rate in intention to treat(ITT) and per protocol(PP) analyses were:7days of levofloxacin-based triple regime group78.3%、83.2%and10days of levofloxacin-based triple regime group81.7%、88.3%. No significant differences were found between the two grouops (P＝0.521and0.277respectively)(2) Make logistic regression analysis on the factors affecting the eradication rate of H. pylori. It suggested that there was no significant correlation between the gender, age, smoking, drinking and the effect of H.pylori eradication. The remission rate of clinical symptom of10days of levofloxacin-based triple regime group was higher than7days of levofloxacin-based triple regime group,90%、80%respectively, and the difference between the two groups was statistically significant (P=0.03).(3)61patients of7days of levofloxacin-based triple regime group agreed to test the concentration of levofloxacin in the gastric mucosa.51patients were successful to eradicate H.pylori infection.10patients were failed to eradicate H.pylori infection. The concentration of levofloxacin in gastric mucosal were7.164±2.097μg/g in the group which was successful to eradicate H. pylori infection, and4.869±1.713μg/g in the group which was failed to eradicate H. pylori infection, and there was statistically significant difference between the two groups (P=0.005).Conclusion:(1) The eradication rate of H.pylori infection in7days of levofloxacin-based triple therapy group was similar to10days of levofloxacin-based triple therapy group, about80%, and it has low side effect、good tolerance and high remission rate of clinical symptom. It can be used as the choice of initial treatment of H.pylori eradication. (2)In7days of levofloxacin-based triple regime group, The levofloxacin concentration in the gastric mucosa can achieve the minimal inhibitory concentration of the levofloxacin to H.ylori strains.The concentration of levofloxacin in the gastric mucosal was higher in the group which was successful to eradicate H. pylori infection than in the group which was failed to eradicate H. pylori infection. It will be further studied about the reasons of the difference of the levofloxacin concentrations in individuals.