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Ann Gastroenterol. 2014;27(4):357-361.

First- and second-line Helicobacter pylori eradication with modified sequential therapy and modified levofloxacin-amoxicillin-based triple therapy.

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Gastroenterology and Digestive Endoscopy, "Nuovo Regina Margherita" Hospital Rome (Angelo Zullo, Cesare Hassan), Italy.
Gastroenterology Unit, Sapienza University of Rome, "Polo Pontino" Hospital, Latina (Lorenzo Ridola, Domenico Alvaro), Italy.
Gastroenterology and Digestive Endoscopy, Israelitic Hospital, Rome (Cesare Efrati, Giorgia Nikolini, Claudio Cannaviello), Italy.
Endoscopy Unit, Ruiniti Hospital, Foggia (Floriana Giorgio, Vincenzo De Francesco), Italy.
Gastroenterology and Digestive Endoscopy; "Versilia" Hospital, Lido di Camaiore (Luigi Gatta), Italy.



Helicobacter pylori (H. pylori) treatment remains a challenge for physicians. Although highly effective, the standard sequential therapy fails in a certain number of patients. Moreover, the cure rate following a levofloxacin-amoxicillin second-line triple therapy seems to be decreasing. We tested the efficacy of modified 10-day sequential therapy, and an intensified levofloxacin-amoxicillin regimen as first- and second-line therapy respectively.


In this prospective, open label, multicenter, pilot study H. pylori-infected patients received a first-line modified 10-day sequential therapy regimen including rabeprazole 20 mg, and amoxicillin 1 g for the first 3 days, followed by rabeprazole 20 mg, clarithromycin 250 mg, and metronidazole 250 mg, for the remaining 7 days, all drugs given thrice daily. An 8-day therapy regimen with rabeprazole 20 mg, levofloxacin 250 mg, and amoxicillin 1 g, all thrice daily, was administered a second-line therapy.


A total of 99 and 15 patients were enrolled for first- and second-line therapy. The eradication rates were 85.9% (95% CI 80-93) and 93.4% (95% CI 88-98) according to ITT and PP analyses following modified sequential therapy, and 60% (95% CI 35-86) and 64.3% (95% CI 39-89) following the intensified second-line therapy.


A modified sequential 3- plus 7-day regimen with thrice daily drug administration failed to achieve very high eradication rate at ITT analysis. The intensified second-line regimen achieved disappointingly low eradication rate. Novel levofloxacin-free second-line therapies are urged in Italy.


Helicobacter pylori; modified levofloxacin triple therapy; modified sequential therapy; second-line therapy; sequential therapy; therapy


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