HIỆU QUẢ DIỆT TRỪ HELICOBACTER PYLORI LẦN HAI CỦA PHÁC ĐỒ BỐN THUỐC CÓ LEVOFLOXACIN SAU THẤT BẠI VỚI PHÁC ĐỒ BỐN THUỐC CÓ BISMUTH

Abstract

Background: Eradication of Helicobacter pylori (H. pylori) is a key component in reducing the burden of many digestive diseases. According to the Consensus of the Vietnam Association of Gastroenterology and the Maastricht VI/Florence Consensus in 2021, levofloxacin-based quadruple therapy is recommended as second-line treatment after failure with the first-line regimen of bismuth-based quadruple therapy. However, recent data on the efficacy of second-line levofloxacin-based quadruple therapy is limited in Vietnam, while antibiotic resistance of H. pylori continues to change. Objectives: We designed this study to (1) evaluate the current eradication rate of second-line levofloxacin-based quadruple therapy in patients who failed the first-line treatment with bismuth-based quadruple therapy. (2) Assess the patient adherence rate to levofloxacin-based quadruple therapy. (3) Investigate related factors affecting the treatment outcomes. Methods: This was a prospective cohort study. We enrolled patients who (1) had failed the first-line H. pylori eradication treatment with bismuth-based quadruple therapy and (2) were treated at the Gastroenterology and Hepatology Outpatient Clinic of the University Medical Center Hospital in Ho Chi Minh City from January 2024 to December 2024. Patients received a 14-day levofloxacin-based quadruple therapy. Post-treatment H. pylori status was assessed 4-12 weeks after the end of the therapy by ¹³C urea breath test and/or rapid urease test. Results: Of the 171 patients enrolled in this study, 69 of them were male. The mean (± SD) age of the participants was 43,9 (± 12,8) years. 91.8% of patients adhered to the treatment. The eradication rate of H. pylori was 79.6% by per-protocol analysis (PP) and 76.0% by modified intention-to-treat analysis (mITT). A statistically significant correlation between treatment outcomes and medication adherence was found (p = 0,001; OR= 7,03, 95%CI: 2,20-22,43)). There was no statistically significant association (p>0,05) between the success rate and age, gender, smoking status, or levofloxacin dose. Conclusion: Levofloxacin-based quadruple therapy demonstrated acceptable eradication rate as a second-line treatment, with high level of patient adherence. Treatment outcomes are significantly correlated with patient adherence.