First-Line Levofloxacin-Based Triple Therapy Versus Standard Bismuth-Based Quadruple Therapy for Eradication in Saudi Arabia: A Retrospective Single-Center Study

Overview

Journal Health Sci Rep

Date 2025 Feb 7

PMID 39917596

Authors

Abdulrhman Khaled Al Abdulqader

Turki Abdullah Alamri

Mahdi Abdullah Alhamad

Somaia Shehab El-Deen

Abdallah Essa

Raed Abdullah Alfayez

Baqer Mohammed Albaqshi

Adnan Salah Almajed

Mohammed Yousef Alhassan

Ali Essa

Ahmed Abdullah Albadrani

Omar Alomair

Bashaeer Abdullh Al Jalal

Mohammed Yousef Almulhim

Abdullah Alotaibi

Ehab Darwish

Affiliations

Soon will be listed here.

Abstract

Background And Aims: Antibiotic resistance in Saudi Arabia has led to decreased efficacy of conventional triple therapy for () eradication, prompting the development of alternative treatments like levofloxacin-based triple and bismuth-based quadruple therapies. However, comparative data regarding its efficacy are lacking. Therefore, this study's goal was to compare the efficacy of levofloxacin-based triple therapy with that of standard bismuth-based quadruple therapy as first-line regimens.

Methods: This retrospective analysis included 197 treatment-naïve adults with infection who received levofloxacin-based triple (levofloxacin + amoxicillin + PPI) therapy ( = 81) or standard bismuth-based quadruple (bismuth + tetracycline + metronidazole + PPI) therapy ( = 116). eradication was evaluated 4-8 weeks after medication administration using the C-urea breath test, and variables that could affect the rate of success were examined.

Results: There were no differences between groups in terms of age, sex, nationality, or type of proton pump inhibitor (PPI) used. The bismuth-based quadruple therapy group exhibited a markedly superior success rate compared to the levofloxacin-based triple therapy group when the latter was administered for 7 or 10 days (81.03% vs. 6.66%, < 0.001, and 81.03% vs. 36.1%, < 0.001, respectively). However, when the levofloxacin-based triple therapy was extended to 14 days, its eradication rate became comparable to that of the 10-day bismuth-based quadruple therapy (81.03% vs. 80%, = 0.898). Eradication rates for both regimens were similar for patients aged ≥ 60, non-Saudi, when using omeprazole and those treated with levofloxacin-based triple therapy for 14 days.

Conclusion: Quadruple treatment based on bismuth is superior to triple therapy based on levofloxacin for eradicating in Saudi Arabia and should be used as a first-line treatment. However, the 14-day levofloxacin-based triple treatment had an eradication rate comparable to that of the 10-day bismuth-based quadruple therapy.

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