Bismuth quadruple therapy versus levofloxacin triple therapy for first-line helicobacter pylori eradication treatment: multicenter study

Background: Bismuth-containing quadruple regimen and levofloxacin-based triple therapy are recommended as first-line therapy in areas with high clarithromycin and metronidazole resistance. However, increasing resistance to levofloxacin in Vietnam can affect the success rate of levofloxacin-based triple therapy. There have been few studies comparing the efficacy of bismuth-based quadruple therapy with levofloxacin-based triple therapy for the first-line treatment of H. pylori infection in our country. Patients and Methods: We included 658 patients with H.pylori infection. However, there were 167 patients lost to follow-up. Four hundred ninety-one patients were randomly assigned either to the bismuth-containing quadruple regimen (Group RBMT, N=252) or to levofloxacin triple (Group RAL, N=239). Both groups treated for 14 days. Eradication of H. pylori was assessed by 13C- urea breath test or Closet 4-8 weeks after therapy. Results: The H. pylori eradication rates of Group RBMT and Group RAL on the intention to treat analysis (ITT) were 84.1% in Group RBMT and 77.4% in Group RAL (P<0.05). The per-protocol eradication rates were 95.9% and 80.1%, respectively (p<0.05). Side effects were significantly higher in the Group RBMT 73.3% than Group RAL 36.4% (p<0.05). The compliance rate of more than 90% of Group RBMT and Group RAL were 78.6% and 88.3% (p<0.05), respectively. Conclusions: A 14-day course of levofloxacin triple therapy appeared to be more productive and better tolerated than a 10-day bismuth-based quadruple therapy in the treatment of persistent H. pylori infection. However, the bismuth-containing quadruple regimen had more adverse effects and lower medication adherence than that of levofloxacin-based triple therapy.