A Comparison of the Efficacy and Tolerability of Quinolone-Based Triple Therapy, Quadruple Therapy, and High-Dose Amoxicillin Therapy in Helicobacter pylori Eradication

Objectives: We aimed to compare the treatment success and patient compliance of triple therapy with levofloxacin, high-dose dual therapy with amoxicillin, and quadruple therapy with bismuth and levofloxacin as first-line treatment for Helicobacter pylori (H. pylori) eradication using amoxicillin 875 mg + clavulanic acid 125 mg instead of amoxicillin 1 g. Methods: Patients who tested positive for Helicobacter pylori in the histopathological examination of biopsies taken during upper gastrointestinal endoscopy were initially divided into three different treatment groups. There were 179 patients in the first group, 178 patients in the second group, and 182 patients in the third group. A total of 480 patients from these groups who came for follow-up were included in this study, with 160 patients in each group receiving one of three different treatment protocols. The first group received treatment with amoxicillin 875 mg + 125 mg clavulanic acid twice daily, levofloxacin 500 mg once daily, and pantoprazole 40 mg twice daily (Group 1). The second group received treatment with amoxicillin 875 mg + 125 mg clavulanic acid three times a day, along with pantoprazole 40 mg twice daily (Group 2) as treatment. The third group received treatment with amoxicillin 875 mg + 125 mg clavulanic acid, twice daily, levofloxacin 500 mg once daily, pantoprazole 40 mg twice daily, and bismuth subsalicylate 262 mg2 pieces four times a day (Group 3). H. pylori was checked with a stool antigen test 45 days after the 14-day treatment. The groups were compared in terms of treatment success and treatment compliance. Results: In Group 1, 150 (90.6%) of 160 patients tested negative for an H. pylori antigen in stool samples on day 45 after treatment. This rate was 139 (86.9%) in Group 2 and 148 (92.5%) in Group 3. There were no statistically significant differences between the three groups in terms of treatment success (p = 0.233). Side effects were observed in 10 (6.2%) patients in Group 1. Side effects were present in nine (5.6%) patients in Group 2. Side effects were observed in 12 (7.5%) patients in Group 3. There was no significant difference between the groups in terms of patient compliance (p = 0.786). Conclusions: Treatment success and side effects were similar in all three groups, with no statistical difference. The combination of amoxicillin 875 mg + clavulanic acid 125 mg is at least as effective as amoxicillin 1 g alone.