Fluoroquinolone-based protocols for eradication of Helicobacter pylori

Table 1 Current recommendations for Helicobacter pylori eradication

Treatment	Region with low clarithromycin prevalence	Region with high clarithromycin prevalence
First line	PPI - clarithromycin - amoxicillin/metronidazole or bismuth quadruple	Bismuth quadruple1. If not available: non-bismuth quadruple (either sequential or concomitant)
Second line	Bismuth quadruple1 or PPI - levofloxacin/amoxicillin	PPI - levofloxacin/amoxicillin
Third line	Based on susceptibility testing only. Besides clarithromycin and levofloxacin, rifabutin is another candidate that may be used

¹PPI + tetracyclines + bismuth + metronidazole. PPI: Proton pump inhibitors.

Table 2 Randomized controlled trials containing levofloxacin in first-line triple therapy of Helicobacter pylori

Ref.	Year	Nation	Patients	Therapy	Posology	Duration	Comparator	ITT
Shah et al[53]	2013	India	131	LTE	500	7		85.0%
Qian et al[54]	2012	China	345	LAE	500	7	SEQ-L	78.1%
Cuadrado-Lavín et al[61]	2012	Spain	250	LAO	500	10	CAO	82.8%
Pan et al[62]	2010	China	199	LAE	500	7	NAR	87.1%
Chen et al[63]	2010	Taiwan	189	LCE	500	7	CAE	78.9%
Assem et al[64]	2010	Egypt	450	LAE	500	7	CLE/CAE	84.7%
Erçin et al[65]	2010	Turkey	91	LAL	500	14	LAL (7)	72.0%
Liou et al[66]	2010	Taiwan	432	LAL	500	7	CAL	74.0%
Chen et al[63]	2010	China	300	LAL	500	7	CAL	74.0%
Molina-Infante et al[69]	2010	Spain	460	LAO	500	10	SEQ-L	82.6%
Castro-Fernández et al[59]	2009	Spain	135	LAO	500	10		71.8%
Gisbert et al[55]	2007	Spain	64	LARBIS	500	10		84.4%
Rispo et al[52]	2007	Italy	130	LAE	500	7	CAE	90.8%
Nista et al[51]	2006	Italy	300	CLE	500	7	CME/CAE	87.0%
Lee et al[56]	2006	South Korea	267	LAE	500	7	CAE	69.8%
Cammarota[50]	2004	Italy	100	CLR	500	7	CLR (250)	84.0%

LTE: Levofloxacin + tinidazole + esomeprazole; LAE: Levofloxacin + amoxicillin + esomeprazole; SEQ-L: Standard sequential therapy or levofloxacin-containing sequential therapy; LAO: Levofloxacin + amoxicillin + omeprazole; CAO: Clarithromycin + amoxicillin + omeprazole; LCE: Levofloxacin + clarithromycin + esomeprazole; CAE: Clarithromycin + amoxicillin + esomeprazole; CLE: Clarithromycin + levofloxacin + esomeprazole; LAL: Levofloxacin + amoxicillin + lansoprazole; CAL: Clarithromycin + amoxicillin + lansoprazole; LARBIS: Levofloxacin + amoxicillin + ranitidine bismuth citrate; CLR: Clarithromycin + levofloxacin + rifabutin; ITT: Intention-to-treat.