Comparison of the efficacy of levofloxacin, omeprazole, nitazoxanide, and doxycycline (LOAD) regimen with standard triple therapy to eradicate Helicobacter pylori infection: a prospective randomized study from a tertiary hospital in India

Helicobacter pylorus is a widespread infection in India. Resistance to commonly used antibiotics against Helicobacter pylori increases rapidly, leading to traditional triple therapy's lower success. So, a search for a new regimen is needed. In this study, we compared the efficacy of 14-day triple therapy with a novel ten-day LOAD regimen to eradicate Helicobacter pylori infection in India .

In this randomized trial, patients with Helicobacter pylori infection were randomized to LOAD therapy (levofloxacin 250 mg OD, omeprazole 40 mg BD, nitazoxanide 500mg BD, and doxycycline 100 mg OD) for ten days and standard triple therapy ( pantoprazole 80 mg, amoxicillin 2000 mg, and clarithromycin 1000 mg daily in divided doses for 14 days ). Gastric biopsy/RUT was done 10–12 weeks after completing therapy to confirm Helicobacter pylori eradication.

The eradication rates with LOAD regimen were significantly greater than with standard triple therapy on both intention-to-treat analysis (82.75 % vs. 60.26 %, p = 0.001; difference, 22.49 % [95 % CI, 8.5-18 %] and per-protocol analysis (83.3 % vs. 62.75 %, p = 0.002; difference, 20.55 % [95 % CI, 7.1-22.5 %]). Both the treatment regimens were well tolerated.

Although the rate of eradication of H. pylori infection with the LOAD regimen was significantly higher than that with triple therapy, the efficacy was still suboptimal. It may be due to fluoroquinolone resistance or a short course of treatment.