ABSTRACT
Aim: This study was aimed to evaluating the efficacy of levofloxacin based sequential therapy vs clarithromycin based sequential therapy in h.pylori [HP] eradication
Background: Several therapeutic regimen were investigated to treat HP infection. Sequential therapy is an alternative to classic triple therapy
Methods: In this randomized clinical trial, 200 HP infected patients randomly divided into two therapeutic groups .1-Levofloxacin based sequential regimen [group A]; omeprazole and amoxicillin for 7days followed by omeprazole, amoxicillin and levofloxacin for 7days. 2-clarithromycin based sequential regimen [group B]: omeprazole and amoxicillin for 7days followed by omeprazole, amoxicillin and clarithromycin for 7days. HP eradication was evaluated with urea breath test with carbon 13 [UBT] 6 weeks after the end of treatment
Results: Per protocol eradication rates of group A and B were 87.6% and 76% respectively. By intention to treat analysis, eradication rate of group A and B groups were 85.1% and 73% respectively. Levofloxacin based sequential regimen was more effective than clarithromycin based sequential regimen [Pv=0.028]. Adverse events were seen in 19.6% and 15.6% in group A and B respectively. Drug compliance was 97% in group A and 96% in group B. There was no significant difference between two groups in term of adverse events [p=0.470] and compliance [p=0.651]
Conclusion: Levofluxacin based sequential therapy was more effective than Clarithromycin based sequential therapy in HP eradication. The suggested Levofluxacin based sequential therapy could be an alternative therapy in area with high clarithromycin resistance. Further studies are needed to confirm these findings
ABSTRACT
Acute meningitis in children is predominantly aseptic and does not require specific treatment. However, meningitis has a bacterial origin in about 5% of patients and carries a risk of fatal outcome or severe neurological sequelae, especially when diagnosis and antibiotic administration are delayed. The objective of the present study was to evaluate the value of determining procalcitonin levels to discriminate between bacterial and non-bacterial meningitis in young children or infants and describe the variation in serum PCT levels over time during the treatment of meningitis. A total of 50 children with meningitis admitted to a University Hospital were followed in this prospective study. Cerebrospinal fluid [CSF] and serum levels of procalcitonin were measured. The diagnosis of meningitis was based on clinical findings, gram staining, culture, and chemical analysis of CSF. Twenty-five children were diagnosed as bacterial meningitis and the other 25 children as non-bacterial Meningitis.The mean procalcitonin level on admission in patients with acute bacterial meningitis was 18.3 ng/mL, and the lower level was 4.6 ng/mL, while the higher level in patients with non-bacterial meningitis was 0.62 ng/mL [mean level, 0.38 ng/mL]. It is clear from the range of serum procalcitonin level that, there are no overlapping values seen for serum procalcitonin in both groups.serum PCT levels can be used in the early diagnosis of acute bacterial meningitis and is more valuable than the other predictive marker. Similarly, they may be useful adjuncts in differential diagnosis of bacterial and non-bacterial meningitis and diminishing the value of 2nd lumbar puncture performed 48-72 hours after admission to assess treatment efficacy