Comparison between Hybrid, Reverse Hybrid, and Non-Bismuth Levofloxacin Quadruple Regimens for Helicobacter Pylori Infection in Egypt: A Randomized Trial

Ayman Fathy El Sayed, Ayman Magd Eldin Mohammad Sadek, Walid Ahmed Ragab Abdelhamid


Background: The prevalence of Helicobacter pylori in developing countries is 50.8%, with the highest occurrence presented in Africa (79.1%). It increases the risk of chronic gastritis, peptic ulcer, cancer stomach, and lymphoma. Standard treatment for Helicobacter pylori eradication is below 80% and evaluation of alternative lines of treatment is needed. We aimed to compare the hybrid, reverse hybrid, and levofloxacin quadruple therapies as first-line therapy in Egypt.

Methods: This was an interventional randomized trial at the internal medicine department clinic. A total number of 330 subjects were selected according to the inclusion criteria. They were divided into three groups: Group 1 (110 subjects had received a reverse hybrid regimen), Group 2 (110 subjects had received a hybrid regimen), and Group 3 (110 subjects had received a non-bismuth levofloxacin quadruple regimen).

Results: Group 3 had a significantly lower eradication rate of 82.7% versus 92.7% and 91.8% in groups 1 and 2, respectively. There were non-significant differences in the incidence rates of adverse events among the three groups.

Conclusion: Both the reverse hybrid and hybrid groups had good eradication rates in the Egyptian population, but non-bismuth levofloxacin quadruple therapy did not obtain sufficient eradication rates.


Hybrid therapy, Reverse hybrid therapy, Helicobacter pylori, Eradication therapy, Levofloxacin, omeprazole, nitazoxanide, and doxycycline (LOND) therapy

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