Eradication of Helicobacter pylori in Jordan, Middle East is it different? A quasi experimental study

Helicobacter pylori is a major cause of peptic ulcer disease and is strongly associated with gastric cancer. Rising resistance to Clarithromycin-based regimens has led to evaluation of alternative therapies, including Levofloxacin-based combinations. This study aimed to compare the efficacy of Clarithromycin- versus Levofloxacin-containing triple therapy in a Jordanian population, and to assess the impact of diagnostic methods and metronidazole use on treatment outcomes.

In this prospective, non-randomized controlled trial, 364 adults with confirmed H. pylori infection were recruited from two governmental hospitals in Jordan. Patients received either Clarithromycin- or Levofloxacin-based triple therapy, with or without metronidazole. Diagnosis and treatment response were assessed using gastric biopsy, rapid urease test, or stool antigen test. Follow-up testing occurred four weeks post-treatment. Chi-square tests and Cramer's V were used for statistical analysis.

The overall eradication rate was 65.1 %. Clarithromycin-based therapy showed a higher eradication rate (70.8 %) than Levofloxacin-based therapy (60.2 %), though the difference was not statistically significant (P = 0.64). Among patients diagnosed via stool antigen testing, Clarithromycin therapy was significantly more effective (66.3 % vs. 40.4 %, P = 0.003). Neither metronidazole addition nor type of proton pump inhibitor influenced eradication outcomes.

Clarithromycin-based therapy may be more effective than Levofloxacin-based regimens, particularly when stool antigen testing is used for diagnosis. These findings emphasize the importance of selecting treatment based on local resistance patterns and diagnostic approaches. Further studies are needed to confirm these results and optimize H. pylori treatment strategies.