Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2014 Jan 21;9(1):e85620.
doi: 10.1371/journal.pone.0085620. eCollection 2014.

Levofloxacin-based first-line therapy versus standard first-line therapy for Helicobacter pylori eradication: meta-analysis of randomized controlled trials

Musthafa Chalikandy Peedikayil  1 , Fahad Ibrahim Alsohaibani  1 , Abdullah Hamad Alkhenizan  2
Affiliations
Meta-Analysis

Levofloxacin-based first-line therapy versus standard first-line therapy for Helicobacter pylori eradication: meta-analysis of randomized controlled trials

Musthafa Chalikandy Peedikayil et al. PLoS One. .

Abstract

Background: First-line levofloxacin-based treatments eradicate Helicobacter pylori with varying success. We examined the efficacy and safety of first-line levofloxacin-based treatment in comparison to standard first-line therapy for H pylori eradication.

Materials and methods: We searched literature databases from Medline, EMBASE, and the Cochrane Register of Randomized Controlled Trials through March 2013 for randomized controlled trials comparing first-line levofloxacin and standard therapy. We included randomized controlled trials conducted only on naïve H pylori infected patients in adults. A systematic review was conducted. Meta-analysis was performed with Review Manager 5.2. Treatment effect was determined by relative risk with a random or fixed model by the Mantel-Haenszel method.

Results: Seven trials were identified with 888 patients receiving 7 days of first-line levofloxacin and 894 treated with standard therapy (Amoxicillin, Clarithromycin and proton pump inhibitor) for 7 days. The overall crude eradication rate in the Levofloxacin group was 79.05% versus 81.4% in the standard group (risk ratio 0.97; 95% CI; 0.93, 1.02). The overall dropout was 46 (5.2%) in the levofloxacin group and 52 (5.8%) for standard therapy. The dizziness was more common among group who took Levofloxacin based treatment and taste disturbance was more common among group who took standard therapy. Meta-analysis of overall adverse events were similar between the two groups with a relative risk of 1.06 (95% CI 0.72, 1.57).

Conclusion: Helicobacter pylori eradication with 7 days of Levofloxacin-based first line therapy was safe and equal compared to 7 days of standard first-line therapy.

PubMed Disclaimer

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Flow chart showing study selection.
Figure 2
Figure 2. Forest plot showing the treatment effect of 7 randomized controlled trials.
The crude eradication rate was similar between Levofloxacin based first line treatment and standard first line treatment for the eradication of H pylori.
Figure 3
Figure 3. The Forest plot showing meta-analysis of common side-effects related to levofloxacin-based first line therapy, and standard first-line therapy.
Overall side effects were equal for both levofloxacin and standard treatment.
Figure 4
Figure 4. Funnel plot of included studies showing symmetrical distribution, and no publication bias.
See this image and copyright information in PMC

References

    1. Correa P (1997) Helicobacter pylori as a pathogen and carcinogen. J Physiol Pharmacol 48 Suppl 4: 19–24. - PubMed
    1. Malfertheiner P, Megraud F, O'Morain CA, Atherton J, Axon ATR, et al. (2012) Management of Helicobacter pylori infection–the Maastricht IV/Florence Consensus Report. Gut 61: 646–64. - PubMed
    1. Bayerdorffer E, Neubauer A, Rudolph B, Thiede C, Lehn N, et al. (1995) Regression of primary gastric lymphoma of mucosa-associated lymphoid tissue type after cure of Helicobacter pylori infection. MALT Lymphoma Study Group. Lancet 345: 1591–4. - PubMed
    1. Jafri NS, Hornung CA, Howden CW (2008) Meta-analysis: sequential therapy appears superior to standard therapy for Helicobacter pylori infection in patients naive to treatment. Ann Intern Med 148: 923–31. - PubMed
    1. Malfertheiner P, Megraud F, O'Morain C, Bazzoli F, El-Omar E, et al. (1997) Current European concepts in the management of Helicobacter pylori infection–the Maastricht Consensus Report. The European Helicobacter Pylori Study Group (EHPSG). Eur J Gastroenterol Hepatol 9: 1–2. - PubMed

MeSH terms