Levofloxacin- and Bismuth-Containing Quadruple Rescue Therapy for H. pylori Infection

Increasing antibiotic resistance is decreasing the success of first-line therapies for Helicobacter pylori infection. Second-line rescue regimens involving either bismuth or levofloxacin have produced varying results. Now, investigators in Spain and Italy have evaluated the combination of levofloxacin and bismuth as rescue therapy in patients for whom first-line therapy had failed.

Two hundred consecutive patients from any of 17 hospitals who had documented failure to eradicate H. pylori were given esomeprazole (40 mg twice daily), amoxicillin (1 g twice daily), bismuth subcitrate (240 mg twice daily), and levofloxacin (500 mg once daily) for 14 days. A total of 192 patients took all medications as prescribed. Successful eradication was conf…