Levofloxacin-Based Regimen Versus Bismuth Quadruple Regimen for Helicobacter pylori Eradication in Kurdistan Region, Iraq

Background: Helicobacter pylori infection is associated with peptic ulcer diseases and gastric adenocarcinoma. Accordingly, the aim of this study was to assess the efficiency of tetracycline quadruple therapy versus levofloxacin-based regimen (LBR) for the eradication of H. pylori. Methods: To this end, ۱۹۷ subjects with H. pylori infection were recruited in this randomized clinical study in Kurdistan region, Iraq between October ۲۰۱۸ and May ۲۰۱۹ and randomly divided into ۲ groups. The LBR group received levofloxacin ۵۰۰ mg one time per day, amoxicillin ۱۰۰۰ mg two times per day, and omeprazole ۲۰ mg two times per day for two weeks. In addition, the tetracycline-metronidazole-bismuth (TMB) group received bismuth subcitrate ۱۴۰ mg, metronidazole ۱۲۵ mg, and tetracycline ۱۲۵ mg plus omeprazole ۲۰ mg twice per day for ۱۰ days. Finally, ۲۸ days after the completion of the treatment course, the eradication of H. pylori was evaluated by the ۱۴C urease breath test. Results: The total eradication rate of H. pylori infection was ۱۴۹/۱۹۷ (۷۵.۶%). Although the success eradication rate in the LBR regimen was ۷۰/۱۱۲ (۶۲.۵%), the eradication success rate was ۷۹/۸۵ (۹۲.۹%) in the TMB regimen (P = ۰.۰۰۱, odds ratio = ۷.۹, confidence interval = ۳.۱۷-۱۹.۷). Finally, gender and age represented on the effect of the eradication rate. Conclusions: In general, the bismuth-based regimen could eradicate a high rate of H. pylori infection. Therefore, this regimen can be used to overcome treatment failure in areas with a high prevalence of antibiotics resistance.