H Pylori Eradication Rates Low in Patients Who Received COVID-19 Treatment

Rising antimicrobial resistance may adversely impact H pylori treatment and increase the risk of H pylori related diseases

Clarithromycin- and levofloxacin-based regimens have low eradication rates of Helicobacter pylori in patients who previously receive treatment for COVID-19 infection, according to study results published in BMC Infectious Diseases.

Researchers conducted an open-label, randomized controlled study that assessed the efficacy of clarithromycin- and levofloxacin-based regimens as first-line eradication therapy of H pylori infection following the treatment with antibiotics between March 21, 2021, and September 30, 2021.

Participants (N=233) aged 18 to 65 years with newly diagnosed H pylori infection who were previously treated for confirmed or suspected COVID-19 were included in the study.

A total of 116 patients received the clarithromycin-based regimen (amoxicillin 1 g every 12 hours, clarithromycin 500 mg every 12 hours, and esomeprazole 40 mg every 12 hours), and 117 received the levofloxacin-based regimen (esomeprazole 40 mg every 12 hours, levofloxacin 500 mg every 24 hours, and amoxicillin 1 g every 12 hours).

The participants were a mean age of 41.9±13.0 years, 58.8% were men, 63.4% were married, 88.0% lived in urban areas, and 60.1% had no history of chronic disease.

Both regimens showed lower than accepted eradication rates among subjects who were previously treated from COVID-19.

All participants experienced an overall H pylori eradication rate of 69.53%. The levofloxacin-based regimen had a 74.36% eradication rate and the clarithromycin-based regimen had a 64.66% eradication rate in the per protocol analysis. Using the intention-to-treat analysis, the researchers observed lower eradication rates in those who received both the levofloxacin-based regimen (64.44%) and the clarithromycin-based regimen (55.56%). These differences were not statistically significant (P =.11, and P =.14 respectively).

Adverse effects were similar in the treatment groups, with 17.2% of participants in the clarithromycin cohort and 13.7% in the levofloxacin cohort experiencing epigastric pain.

Limitations of the study include the fact that exact time between COVID-19 treatment and enrollment was not used, and the type of antibiotic used by each patient during COVID-19 treatment was not documented.

The researchers conclude, “Both regimens showed lower than accepted eradication rates among subjects who were previously treated from COVID-19. This should raise the alarm about the increase in antibiotic resistance among these persons and among the community as a whole. This rising resistance can adversely impact the costs of H pylori treatment and increase the risk of H pylori-related diseases.”

This article originally appeared on Gastroenterology Advisor


Kamal A, Ghazy RM, Sherief D, Ismail A, Ellakany WI. Helicobacter pylori eradication rates using clarithromycin and levofloxacin-based regimens in patients with previous COVID-19 treatment: a randomized clinical trial. BMC Infect Dis. 2023;23(1):36. doi:10.1186/s12879-023-07993-8