sentence: A total of 460 patients were randomized into four 10-day therapeutic schemes ( 115 patients per group ): ( i ) standard OCA , omeprazole , clarithromycin and amoxicillin ; ( ii ) triple OLA , omeprazole , levofloxacin and amoxicillin ; ( iii ) sequential OACM , omeprazole plus amoxicillin for 5 days , followed by omeprazole plus clarithromycin plus metronidazole for 5 days ; and ( iv ) modified sequential OALM , using levofloxacin instead of clarithromycin .
paragraph: Clinical trial: clarithromycin vs. levofloxacin in first-line triple and sequential regimens for Helicobacter pylori eradication. Helicobacter pylori eradication rates with standard triple therapy have declined to unacceptable levels. ### aim To compare clarithromycin and levofloxacin in triple and sequential first-line regimens. ### methods A total of 460 patients were randomized into four 10-day therapeutic schemes ( 115 patients per group ): ( i ) standard OCA , omeprazole , clarithromycin and amoxicillin ; ( ii ) triple OLA , omeprazole , levofloxacin and amoxicillin ; ( iii ) sequential OACM , omeprazole plus amoxicillin for 5 days , followed by omeprazole plus clarithromycin plus metronidazole for 5 days ; and ( iv ) modified sequential OALM , using levofloxacin instead of clarithromycin . Eradication was confirmed by 13C-urea breath test. Adverse effects and compliance were assessed by a questionnaire. ### results Per protocol cure rates were: OCA (66%; 95% CI: 57-74%), OLA (82.6%; 75-89%), OACM (80.8%; 73-88%) and OALM (85.2%; 78-91%). Intention-to-treat cure rates were: OCA (64%; 55-73%), OLA (80.8%; 73-88%), OACM (76.5%; 69-85%) and OALM (82.5%; 75-89%). Eradication rates were lower with OCA than with all the other regimens (P < 0.05). No differences in compliance or adverse effects were demonstrated among treatments. ### conclusions levofloxacin-based and sequential therapy are superior to standard triple scheme as first-line regimens in a setting with high clarithromycin resistance. However, all of these therapies still have a 20% failure rate.