title: Levofloxacin based sequential and triple therapy compared with standard plus probiotic combination for Helicobacter pylori eradication.
abstract: OBJECTIVE
  Development of resistance to standard therapy for Helicobacter pylori (H. pylori) eradication is rapid. The aim of this study is to compare the efficacy of alternative treatment modalities for H. pylori. Compared treatments were standard triple treatment plus probiotic, sequential therapy with levofloxacin, and a 14-day regimen of PPI (proton pump inhibitor) and levofloxacin/amoxicillin combination.
  
  
  METHODS
  Overall 285 patients were enrolled in the study and allocated into three groups. Group I (n=98) received lansoprazole, clarithromycin, amoxicillin and saccharomyces boulardii (probiotic) and group II (n=95) received esomeprazole, levofloxacin and amoxicillin for 14 days. Finally, group III (n=92) received esomeprazole and amoxicillin for five days, followed by esomeprazole, levofloxacin and metronidazole for seven days. Testing for H. pylori infection post-treatment was done using a stool antigen test five weeks after the completion of therapy.
  
  
  RESULTS
  Patients in all three groups were treatment-naive. Response to treatment (Per Protocol/ITT analysis) was 77.1/72.4% in Group I, 89.1/86.3% in Group II, and 95.5% in Group III. Response to treatment was significantly higher in Groups II and III compared to Group I (p=0.03 and p<0.001, respectively). There was no difference between Groups II and III in terms of response to treatment (p=0.1).
  
  
  CONCLUSIONS
  Levofloxacin-based sequential therapy and levofloxacin based triple therapy were significantly superior to standard triple therapy plus probiotic.
authors.affiliation: Department of Gstroenterology, Umraniye Education and Research Hospital, Istanbul, Turkey.
authors.forename: Kamil
authors.initials: K
authors.lastname: Ozdil
authors.forename: Turan
authors.initials: T
authors.lastname: Calhan
authors.forename: Abdurrahman
authors.initials: A
authors.lastname: Sahin
authors.forename: Ebubekir
authors.initials: E
authors.lastname: Senates
authors.forename: Resul
authors.initials: R
authors.lastname: Kahraman
authors.forename: Bilgehan
authors.initials: B
authors.lastname: Yüzbasioglu
authors.forename: Hakan
authors.initials: H
authors.lastname: Demirdag
authors.forename: Hüseyin
authors.initials: H
authors.lastname: Demirsoy
authors.forename: Mehmet H
authors.initials: MH
authors.lastname: Sökmen
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D004359:Drug Therapy, Combination; D005260:Female; D016481:Helicobacter Infections / Q000188:drug therapy*; D016480:Helicobacter pylori; D006801:Humans; D064704:Levofloxacin; D008297:Male; D008875:Middle Aged; D015242:Ofloxacin / Q000008:administration & dosage*; D019936:Probiotics / Q000008:administration & dosage*; D011446:Prospective Studies; D054328:Proton Pump Inhibitors / Q000008:administration & dosage
chemical_list: D000900:Anti-Bacterial Agents; D054328:Proton Pump Inhibitors; D064704:Levofloxacin; D015242:Ofloxacin