[Effectiveness and Safety of Proton Pump Inhibitor and Levofloxacin Based First-line Triple Therapy in the Eradication of Helicobacter Pylori: a Meta-analysis]

Objective: To evaluate the effectiveness and safety of the proton pump inhibitor and levofloxacin based first-line triple therapy in the eradication of Helicobacter pylori (Hp).

Methods: Correlated randomized controlled clinical trials (RCTs) evaluating the effectiveness and safety of proton pump inhibitor and levofloxacin based first-line triple therapy to eradicate Hp were searched in Medline, Embase, OVID, Cochrane Library, Clinical evidence online, Socolar searching platform, and National Knowledge Infrastructure (1994 - 2008). The final searching date was 17 May 2008. The quality of trials was assessed according to the Jadad standard. Effective model for calculation was selected according to statistical heterogeneity between the trials evaluated by Stata 9.0. Egger regression model and trim-and-fill method were utilized to evaluate publication bias, and trim and fill method was employed to estimate the outcomes of the articles unpublished.

Results: Eleven RCTs including 1926 cases were selected for analysis in accordance with the enrollment criteria. As the first line treatment, proton pump inhibitor and levofloxacin based triple therapy was more effective than standard triple therapy (total OR = 1.56, 95%CI = 1.25 - 1.94, P = 0.000), had lower side effect rate than standard triple therapy (total OR = 0.57, 95%CI = 0.44 - 0.74, P = 0.000), and there was no significant difference in the compliance with the two therapies (total OR = 0.72, 95%CI = 0.34 - 1.49, P = 0.374).

Conclusion: Proton pump inhibitor and levofloxacin based triple therapy is effective in the eradication of Hp, and should be advocated to be the first-line regime in the treatment of Hp.