title: Systematic review with meta-analysis: the efficacy of levofloxacin triple therapy as the first- or second-line treatments of Helicobacter pylori infection.
abstract: BACKGROUND
  Levofloxacin triple therapy has been used for the first-line and second-line treatment of Helicobacter pylori infection for more than 10 years.
  
  
  OBJECTIVE
  To systematically review the efficacy of levofloxacin triple therapy in the first- and second-line treatment, and to assess the time trend and factors that might affect its efficacy.
  
  
  METHODS
  Prospective trials reporting the efficacy of levofloxacin triple therapy in either the first-line or second-line treatment of H. pylori infection in adults were searched from the PubMed and Cochrane database from January 2000 to September 2015. Meta-analysis was performed to calculate the cumulative eradication rate and the efficacies in subgroups.
  
  
  RESULTS
  Of the 322 articles identified, a total of 4574 patients from 41 trials, including 16 trials in the first-line treatment and 25 trials in the second-line treatment were eligible for analysis. The cumulative eradication rate was 77.3% (95% confidence intervals, CI: 74.7-79.6) and was 80.7% (95% CI 77.1-83.7) in the first-line treatment and 74.5% (95% CI: 70.9-77.8) in the second-line treatment. The efficacies of levofloxacin triple therapy before 2008, between 2009 and 2011, and after 2012 were 77.4%, 79.6% and 74.8% respectively. The eradication rate was higher when levofloxacin was given once daily (80.6%, 95% CI: 77.1-83.7) than twice daily (73.6%, 95% CI: 69.7-77.2). The efficacy was significantly higher in levofloxacin-susceptible strains than resistant strains (81.1% vs. 36.3%, risk ratio 2.18, 95% CI: 1.6-3, P < 0.001).
  
  
  CONCLUSIONS
  The efficacy of levofloxacin triple therapy has been lower than 80% in many countries and it is not recommended when the levofloxacin resistance is higher than 5-10%.
authors.affiliation: Department of Internal Medicine, Ditmanson Medication Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan.
authors.forename: P-Y
authors.initials: PY
authors.lastname: Chen
authors.affiliation: Departments of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
authors.forename: M-S
authors.initials: MS
authors.lastname: Wu
authors.affiliation: Department of Internal Medicine, Ditmanson Medication Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan.
authors.forename: C-Y
authors.initials: CY
authors.lastname: Chen
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Mackay Memorial Hospital, Taitung Branch, Taiwan.|Department of Nursing, Meiho University, Pingtung, Taiwan.
authors.forename: M-J
authors.initials: MJ
authors.lastname: Bair
authors.affiliation: Department of Internal Medicine, Ditmanson Medication Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan.
authors.forename: C-K
authors.initials: CK
authors.lastname: Chou
authors.affiliation: Departments of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.|School of Medicine and Big Data Research Centre, Fu Jen Catholic University, New Taipei City, Taiwan.
authors.forename: J-T
authors.initials: JT
authors.lastname: Lin
authors.affiliation: Departments of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
authors.forename: J-M
authors.initials: JM
authors.lastname: Liou
mesh_terms: D000328:Adult; D000658:Amoxicillin / Q000008:administration & dosage; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D002986:Clinical Trials as Topic / Q000379:methods; D016208:Databases, Factual; D024881:Drug Resistance, Bacterial; D004359:Drug Therapy, Combination; D016481:Helicobacter Infections / Q000175:diagnosis* / Q000188:drug therapy*; D016480:Helicobacter pylori / Q000187:drug effects* / Q000502:physiology; D006801:Humans; D064704:Levofloxacin / Q000008:administration & dosage*; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D064704:Levofloxacin; D000658:Amoxicillin