Empirical Third-Line Therapy for Refractory H. pylori Infection

Success in eradicating Helicobacter pylori depends in part on bacterial susceptibility to the antibiotics used. The recent Maastricht III Consensus Report provided guidance for therapy based on local prevalence of antibiotic resistance and recommended cultures for antibiotic-susceptibility testing after failure of first- and second-line therapies. Investigators in Greece recently evaluated empirical use of a levofloxacin-based third-line therapy without susceptibility testing in patients with persistent H. pylori infection after first- and second-line therapies.

The study involved 540 consecutive patients with H. pylori infection. All patients were treated with omeprazole, amoxicillin, and clarithromycin for 10 days. Patients with persistent…