Efficacy of tailored second-line therapy of Helicobacter pylori eradication in patients with clarithromycin-based treatm

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Gut Pathogens Open Access

RESEARCH

Efficacy of tailored second‑line therapy of Helicobacter pylori eradication in patients with clarithromycin‑based treatment failure: a multicenter prospective study Siya Kong1,2†, Keting Huang1,2†, Jun Wang3†, Xiaoyong Wang4, Ningmin Yang5, Yu Dong1, Ya Zhuang2, Yini Dang1,2, Guoxin Zhang1,2*† and Feng Ye1,2*† 

Abstract  Background:  After the failure of clarithromycin- and bismuth-based quadruple therapy (CBQT), levofloxacin- and bismuth-based quadruple therapy (LBQT) is recommended for Helicobacter pylori eradication. We compared the efficacies of second-line tailored bismuth-based quadruple therapy (TBQT) and empirical LBQT. Methods:  Patients with CBQT failure were randomly assigned to receive TBQT or LBQT for 14 days. All patients underwent endoscopy for culture-based antibiotic susceptibility testing. Patients in the TBQT group exhibiting levofloxacin susceptibility were randomized to receive amoxicillin, levofloxacin, esomeprazole, and colloidal bismuth pectin (ALEB) or amoxicillin, furazolidone, esomeprazole, and colloidal bismuth pectin (AFEB) for 14 days; patients with levofloxacin resistance received AFEB. Results:  From May 2016 to June 2019, 364 subjects were enrolled. Eradication rates were significantly higher in the TBQT group (n = 182) than in the LBQT group (n = 182) according to both intention-to-treat (ITT) analysis (89.6% vs. 64.8%, P