Gisbert, J. P.Romano, M.Gravina, A. G.Solis-Munoz, P.Bermejo, F.Molina-Infante, J.Castro-Fernandez, M.Ortuno, J.Lucendo, A. J.Herranz, M.Modolell, I.del Castillo, F.Gomez, J.Barrio, J.Velayos, B.Gomez, B.Dominguez, J. L.Miranda, A.Martorano, M.Algaba, A.Pabon-Carrasco, ManuelAngueira, T.Fernandez-Salazar, L.Federico, A.Marin, A. C.McNicholl, A. G.2025-01-312025-01-312015-02-23Gisbert JP, Romano M, Gravina AG, Solís-Muñoz P, Bermejo F, Molina-Infante J, et al. Helicobacter pylori second-line rescue therapy with levofloxacin- and bismuth-containing quadruple therapy, after failure of standard triple or non-bismuth quadruple treatments. Aliment Pharmacol Ther. 2015 Apr;41(8):768-75.0269-2813https://hdl.handle.net/10668/28461Background: The most commonly used second-line Helicobacter pylori eradication regimens are bismuth-containing quadruple therapy and levofloxacin-containing triple therapy, both offering suboptimal results. Combining bismuth and levofloxacin may enhance the efficacy of rescue eradication regimens. Aims: To evaluate the efficacy and tolerability of a second-line quadruple regimen containing levofloxacin and bismuth in patients whose previous H. pylori eradication treatment failed. Methods: This was a prospective multicenter study including patients in whom a standard triple therapy (PPI-clarithromycin-amoxicillin) or a non-bismuth quadruple therapy (PPI-clarithromycin-amoxicillin-metronidazole, either sequential or concomitant) had failed. Esomeprazole (40mg b.d.), amoxicillin (1g b.d.), levofloxacin (500mg o.d.) and bismuth (240mg b.d.) was prescribed for 14days. Eradication was confirmed by C-13-urea breath test. Compliance was determined through questioning and recovery of empty medication envelopes. Incidence of adverse effects was evaluated by questionnaires. Results: 200 patients were included consecutively (mean age 47years, 67% women, 13% ulcer). Previous failed therapy included: standard clarithromycin triple therapy (131 patients), sequential (32) and concomitant (37). A total of 96% took all medications correctly. Per-protocol and intention-to-treat eradication rates were 91.1% (95%CI=87-95%) and 90% (95%CI=86-94%). Cure rates were similar regardless of previous (failed) treatment or country of origin. Adverse effects were reported in 46% of patients, most commonly nausea (17%) and diarrhoea (16%); 3% were intense but none was serious. Conclusions: Fourteen-day bismuth- and levofloxacin-containing quadruple therapy is an effective (90% cure rate), simple and safe second-line strategy in patients whose previous standard triple or non-bismuth quadruple (sequential or concomitant) therapies have failed.enConcomitant therapySequential therapyEradicationInfectionResistenceEfficacyHelicobacter InfectionsAnti-Bacterial AgentsDrug Resistance, BacterialProton Pumps InhibitorsBismuthresearch article25703120restricted accessInfecciones por HelicobacterAgentes AntibacterianosInhibidores de la Bomba de ProtonesResistencia Bacteriana a los MedicamentosBismuto10.1111/apt.13128WOS:000351463000006