Levofloxacin-based therapy as an efficient alternative for eradicating Helicobacter pylori infection in Iran: a systematic review and meta-analysis

Objectives: Despite excessive resistance of Helicobacter pylori to clarithromycin among the Iranian popu-lation, clarithromycin-based therapy is still prescribed in Iran. Recent studies have shown high rates of H. pylori eradication in patients treated with levofloxacin. The main purpose of this study was to com-pare the effect of levofloxacin with clarithromycin on the eradication of H. pylori infection in the Iranian population.Methods: A comprehensive meta-analysis was done for relevant cohort studies and clinical trials to com-pare the therapeutic effects of levofloxacin and clarithromycin in the Iranian population. We pooled the data using odds ratio (OR) and corresponding 95% confidence interval (CI) to determine the clinical effi-cacy of levofloxacin versus clarithromycin to treat H. pylori infection. Heterogeneity and publication bias were also measured for the included studies.Results: Thirteen studies were included in the quantitative synthesis. The eradication rate was signifi-cantly higher in patients receiving levofloxacin compared with clarithromycin (75.2% vs. 66.3%; OR = 1.76, 95% CI 1.40-2.20). Additionally, in the subgroup analyses it was confirmed that the cure rate was rela-tively higher in levofloxacin-treated cases. However, there was significant heterogeneity and publication bias, thus the results should be interpreted with caution.Conclusion: We found that the success of levofloxacin treatment was significantly higher than clar-ithromycin. Therefore, it is suggested that clarithromycin-based triple therapy be replaced by levofloxacin-based triple therapy in countries with high resistance to clarithromycin such as Iran. Nevertheless, the findings of this study need to be approved with a larger investigation on the Iranian population.(c) 2021 The Author(s). Published by Elsevier Ltd on behalf of International Society for Antimicrobial Chemotherapy. This is an open access article under the CC BY-NC-ND license ( http://creativecommons.org/licenses/by-nc-nd/4.0/ )