Clinical outcomes of Helicobacter pylori eradication with levofloxacin in immune thrombocytopenia: a prospective controlled study in Iraq.

BACKGROUND

Immune thrombocytopenia (ITP) is an autoimmune hematologic disorder characterized by isolated thrombocytopenia. There is a suggestion of the possibility that Helicobacter pylori infection plays a role in the immune-mediated destruction of platelets and eradication therapy can yield improvement in platelet recovery. This study aimed to evaluate the impact of levofloxacin-based Helicobacter pylori eradication therapy on platelet response, response categories, and medication adherence in Iraqi patients with H. pylori-positive Immune Thrombocytopenia (ITP).

METHODS

This prospective, interventional, open-label study was conducted in Baghdad. Fifty adult H. pylori-positive ITP patients were randomized into two groups: Group A (n = 25) received levofloxacin-based triple therapy for 14 days in addition to standard ITP treatment, while Group B (n = 25) received standard ITP treatment only. Platelet counts and response categories were assessed at baseline and at 6 weeks. Adherence was measured using the four-item Morisky scale and pill counts.

RESULTS

Baseline platelet counts were similar between groups (36.84 ± 25.82 vs 30.40 ± 18.31 × 109/L; p ≥ 0.05). Significantly, platelet counts increased at 6 weeks in both groups (p < 0.001), but the mean difference in platelet counts was greater in Group A than in Group B (40.56 ± 16.18 vs 11.64 ± 10.36 × 109/L; p < 0.001). The complete response (CR) was 28·0% in group A vs 0% in group B (P < 0.05), with markers of high compliance demonstrated in 40·0% in group A, yielding an 80% overall rate of eradication success.

CONCLUSIONS

Levofloxacin-based H. pylori eradication therapy significantly enhances platelet recovery and response outcomes in patients with ITP. While medication adherence stands as a core driver of clinical outcome, post-treatment platelet fluctuations represent a downstream clinical biomarker of eradication success.