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Helicobacter. 2012 Aug;17(4):246-53. doi: 10.1111/j.1523-5378.2012.00945.x. Epub 2012 Mar 20.

Helicobacter pylori infection: sequential therapy followed by levofloxacin-containing triple therapy provides a good cumulative eradication rate.

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Gastroenterology Unit, Department of Medicine, Sant'Anna Hospital-AUSL of Reggio Emilia, Castelnovo ne' Monti, Italy.



In the eradication of H. pylori infection, even today, the main international guidelines recommend the triple therapy as first-line regimen, although its effectiveness is clearly decreasing. As second-line treatment, the bismuth-containing quadruple therapy is the most used regimen, although several other therapies are studied. The Italian guidelines recommend, alternatively, sequential therapy or triple therapy as first-line treatment and levofloxacin-containing triple therapy as second-line regimen. We wanted to assess the overall eradication rate of Helicobacter pylori infection in two therapeutic rounds following the Italian guidelines in clinical practice.


We treated 231 consecutive Helicobacter pylori-positive patients by sequential therapy and we verified the eradication 8-10 weeks after treatment by stool antigen test. Patients positive for stool antigen test received levofloxacin-containing triple therapy, as second-line therapy, according to Italian Guidelines and they were again submitted to the fecal test 8-10 weeks after the end of treatment.


In the first-line regimen, we obtained an eradication rate of 92.6%, in the second-line of 75.0% and as cumulative result we achieved a 97.8% of eradication, in per-protocol analysis.


Sequential therapy as first-line and levofloxacin-containing triple therapy as second-line represent a good combination to eradicate Helicobacter pylori infection in only two rounds.

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