Is levofloxacin-based triple therapy an alternative for first-line eradication of Helicobacter pylori? A systematic review and meta-analysis

To evaluate the available data on the efficacy and safety of levofloxacin-based triple therapy compared with standard triple therapy in first-line treatment for Helicobacter pylori infection. Methods. By searching MEDLINE, The Cochrane Central Register of Controlled Trials, and Web of Knowledge, two independent reviewers systemically identified randomized controlled trials comparing levofloxacin-based triple regimen with standard triple therapy for first-line treatment of H. pylori infection. The pooled risk ratios (RR) and 95% confidence intervals were calculated. Results. Overall, nine randomized controlled trials including 1275 patients have been treated with levofloxacin-based triple therapy and 1237 patients with standard regimen. Eradication rate in the levofloxacin-based therapy group was slightly higher than that in the standard triple therapy group regardless of treatment duration (80.2% vs. 77.4%, RR = 1.03, 95% CI = 0.94-1.13). Subgroup analysis related to different geographic areas found that efficacy of 7-day standard triple regimen was statistically superior to 7-day levofloxacin-based scheme in Asian group (RR = 0.91, 95% CI = 0.86-0.97), but levofloxacin-based triple therapy was predominant regardless of treatment time in European countries (RR = 1.15, 95% CI = 1.06-1.23). There was no significant difference between two groups in the incidence of overall adverse events or in the occurrence of discontinuing therapy due to side effects. Conclusions. The 10-day levofloxacin-based triple therapy may be considered as an alternative for increasing cure rate of H. pylori infection in European areas. But in Asian countries, standard triple regimen is still superior to levofloxacin-based therapy as first-line regimen for H. pylori eradication.