Comparison of Two Triple Therapy Regimens for Helicobacter pylori Eradication in Patients with Dyspepsia: A Retrospective Study from Primary Care

Background and Objective: Helicobacter pylori infection remains a major cause of chronic gastritis, dyspepsia, and peptic ulcer disease worldwide. Increasing antibiotic resistance, particularly to clarithromycin, has reduced the effectiveness of standard eradication therapies. The aim of this study was to compare the effectiveness of two triple therapy regimens for Helicobacter pylori eradication in patients presenting with dyspepsia in primary care and to evaluate the influence of demographic, clinical, and lifestyle factors on treatment outcomes. Methods: This retrospective study included 1800 adult patients with dyspeptic symptoms and confirmed Helicobacter pylori infection who received triple therapy between January 2023 and early 2026 in a primary care setting. Patients were treated with either clarithromycin 500 mg, amoxicillin 1000 mg, and pantoprazole 20 mg, or levofloxacin 500 mg, amoxicillin 1000 mg, and pantoprazole 20 mg. Clinical reassessment and therapy review were performed after 21 days. Eradication status was evaluated using stool antigen testing after completion of therapy. Data extracted from medical records included age, sex, body mass index, smoking status, alcohol consumption, obesity, diabetes mellitus, history of gastroduodenal disease, and chronic use of non-steroidal anti-inflammatory drugs. Statistical analysis included descriptive statistics, chi-square testing, and multivariable logistic regression to identify factors associated with eradication success. Statistical significance was considered at p < 0.05. Results: Among 1800 patients, 52 percent were male and the mean age was 47 years. The levofloxacin-based regimen achieved a significantly higher eradication rate compared with the clarithromycin-based regimen, 82.9 percent versus 71.8 percent, p < 0.001. Treatment failure was more frequent among active smokers, obese patients, alcohol consumers, and individuals with diabetes mellitus. In multivariable analysis, treatment with a levofloxacin-based regimen remained an independent predictor of successful eradication with an odds ratio of 1.88 and p < 0.001. Smoking, obesity, and diabetes were independently associated with lower eradication success. Adverse effects were reported in 13.9 percent of patients receiving clarithromycin and 9.1 percent of those receiving levofloxacin, with a statistically significant difference between the groups, p = 0.002. Conclusions: Levofloxacin-based triple therapy demonstrated superior effectiveness compared with the clarithromycin-based regimen for Helicobacter pylori eradication in patients with dyspepsia in primary care. Lifestyle factors and metabolic comorbidities appear to influence treatment outcomes and should be considered when selecting eradication strategies in routine clinical practice.