Comparison of levofloxacin versus clarithromycin efficacy in the eradication of Helicobacter pylori infection

Background: Helicobacter pylori (H.pylori) infection causes multiple upper gastrointestinal diseases but optimal therapeutic regimen which can eradicate infection in all the cases has not yet been defined. This study was designed to evaluate the efficacy of triple levofloxacin-based versus clarithromycin-based therapy. Methods: In this open-label randomized clinical trial study 120 patients who had esophagogastroduodenoscopy (EGD) with positive rapid urease test (RUT) were enrolled and divided into 2 groups. Case group was treated with levofloxacin (500 mg daily) plus amoxicillin (1 gr twice a day) plus omeprazole (20 mg daily) for 2 weeks. Control group was treated with clarithromycin (500 mg twice a day) plus omeprazole (20 mg daily) for 2 weeks. After the main course of treatment, they received maintenance treatment with omeprazole for 4 weeks. Stool antigen test was performed on them after two weeks of not having any medicine. Results: H.pylori eradication (intention to treat analysis) was successful in 75% of case group and 51.7% of control group showing a significant difference (P=0.008). H.p infection eradication (per-protocol analysis) was successful in 80.4% in case group and 57.4%% in control group showing significant difference (P=0.009). Drugs adverse effects causing discontinuation treatment were seen in 5% of case group and 3.3% of control group which have not shown a significant difference between the two groups (P=0.648). Conclusion: Triple therapy with levofloxacin-based regimen has better efficacy than clarithromycin-based regimen and as safe as it is. Keywords: Helicobacter pylori, Dyspepsia, Peptic ulcer, Rapid urease test, Stool antige

Effect of adding garlic extract to anti-helicobacter pylori treatment تأثير افزودن عصاره سير به رژيم درماني ضد هليكوباكترپيلوري

چكيد

Treatment Outcome in Chronic Hepatitis C Infection: A Four Years Survey Among Iranian Patients

Abstract Background: Hepatitis C virus (HCV) infection is universal. Side effects of its treatment are observed in many patients. The present study was designed to evaluate treatment outcome and side effects of the treatment in chronic HCV infection. Materials and Methods: The current study was conducted prospectively on patients with hepatitis C infection. They had been treated with the standard drug regimen, if indicated. They were followed for treatment response, side effects of therapy, and its related factors. Findings: From ninety one patients, eighty four persons finished their treatment course. They comprised 71 (84.5%) males and 13 (15.5%) females. Their mean age was 41.5± 11.90 years (20-69 years). Genotype 3 was the most common virus genotype (51.2%). Sustained virologic response (SVR) was 84.5% for genotype 3 and 47.5% for genotype 1. Decrease in hemoglobin (43%), weakness and fatigue (26%), neutropenia (13%), and thrombocytopenia (13%) were the most common side effects of the treatment. Seven patients can not finish their treatment course, because of the side effects. Conclusion: Genotype 3, viral load less than 600000, and more than 3- fold rise in AST are associated with higher SVR. Early administration of the added drugs such as erythropoietin and G-CSF to not reduce the drug doses were also influential. Keywords: chronic hepatitis C, SVR, Peg-interferon, α-2a pegaferon, ribavirin, treatmen

Conservative Management of Colonoscopic Perforation: A Case Report

Colonoscopy is widely used for the diagnosis, treatment and a follow up of colorectal diseases. Perforation of the large bowel during elective colonoscopy is rare but serious life threatening complication. We report a 51-year-old woman who experienced recto sigmoid perforation during diagnostic colonoscopy. During 8 days of total hospitalization, she spent 3 days in ICU with gastrointestinal rest. The patient was hydrated and took intravenous antibiotics. In take-output and temperature were closely monitored. Serial abdominal examinations were performed to rule out peritonitis. After transferring to surgery ward in the day 4, liquid diet started slowly, and she was ambulated. At the day 8, she was discharged with the good clinical condition. Conservative management of the patients with early diagnosis of perforation and no signs and symptoms of peritonitis or sepsis could be the modality of choice