First-line triple therapy with levofloxacin for Helicobacter pylori eradication

Aliment Pharmacol Ther. 2007 Aug 1;26(3):495-500. doi: 10.1111/j.1365-2036.2007.03384.x.


Background: At present, the efficacy of proton pump inhibitor-clarithromycin-amoxicillin regimen is relatively low.

Aim: To evaluate the efficacy and tolerability of a first-line triple clarithromycin-free regimen including ranitidine bismuth citrate, levofloxacin and amoxicillin.

Design: Prospective study.

Patients: Helicobacter pylori-positive patients complaining of dyspeptic symptoms referred for gastroscopy.

Intervention: Levofloxacin (500 mg b.d.), amoxicillin (1 g b.d.) and ranitidine bismuth citrate (400 mg b.d.) was prescribed for 10 days.

Outcome: Eradication was confirmed by a (13)C-urea breath test 8 weeks after therapy. Compliance with therapy was determined by questioning and the recovery of empty envelopes of medications. Incidence of adverse effects was evaluated by means of a specific questionnaire.

Results: Sixty-four patients were included (30% peptic ulcer, 70% functional dyspepsia). Almost all (97%) patients took all the medications correctly. Per-protocol and intention-to-treat eradication rates were 88.5% (95% CI =78-95%) and 84.4 (74-91%). Adverse effects were reported in 9.5% of the patients, mainly including diarrhoea (7.9%); none of them were severe.

Conclusion: This new 10-day levofloxacin-based combination represents an alternative to clarithromycin-based therapy, as it meets the criteria set for regimens used as primary H. pylori treatment: effectiveness (>80%), simplicity (twice-daily dosing and excellent compliance) and safety (low incidence of adverse effects).

Publication types

  • Clinical Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Amoxicillin / administration & dosage
  • Anti-Bacterial Agents / administration & dosage
  • Anti-Bacterial Agents / therapeutic use*
  • Anti-Ulcer Agents / administration & dosage
  • Anti-Ulcer Agents / therapeutic use*
  • Bismuth / administration & dosage
  • Drug Therapy, Combination
  • Female
  • Follow-Up Studies
  • Helicobacter Infections / drug therapy*
  • Helicobacter pylori*
  • Humans
  • Levofloxacin*
  • Male
  • Middle Aged
  • Ofloxacin / administration & dosage
  • Ofloxacin / therapeutic use*
  • Prospective Studies
  • Ranitidine / administration & dosage
  • Ranitidine / analogs & derivatives
  • Treatment Outcome


  • Anti-Bacterial Agents
  • Anti-Ulcer Agents
  • Levofloxacin
  • ranitidine bismuth citrate
  • Amoxicillin
  • Ranitidine
  • Ofloxacin
  • Bismuth