Lansoprazole, levofloxacin and amoxicillin triple therapy vs. quadruple therapy as second-line treatment of resistant Helicobacter pylori infection

Aliment Pharmacol Ther. 2006 Feb 1;23(3):421-7. doi: 10.1111/j.1365-2036.2006.02764.x.


Aim: To test the efficacy of levofloxacin-based second-line therapy for resistant Helicobacter pylori infection.

Methods: One hundred and six patients who failed H. pylori eradication were randomized to receive (i) lansoprazole 30 mg, amoxicillin 1 g, levofloxacin 500 mg, all given twice daily for 7 days (LAL); or (ii) lansoprazole 30 mg twice daily, metronidazole 400 mg thrice daily, bismuth subcitrate 120 mg and tetracycline 500 mg four times daily for 7 days (quadruple). Post-treatment H. pylori status was determined by (13)C-urea breath test.

Results: Intention-to-treat and per-protocol H. pylori eradication rates were 57/60% for the LAL group and 71/76% for the quadruple group respectively. Metronidazole, clarithromycin, amoxicillin and levofloxacin resistance were found in 76%, 71%, 0% and 18% of patients, respectively. Levofloxacin resistance led to treatment failure in the LAL group. For patients with dual resistance to metronidazole and clarithromycin, the eradication rates were 79% in the LAL group (levofloxacin-sensitive) and 65% in the quadruple group (P=0.34).

Conclusion: Lansoprazole, amoxicillin plus levofloxacin second-line therapy is comparable with quadruple therapy in efficacy. Subjects, especially those with dual resistance to metronidazole and clarithromycin, may consider levofloxacin-based therapy for levofloxacin-sensitive strains.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • 2-Pyridinylmethylsulfinylbenzimidazoles
  • Adult
  • Aged
  • Amoxicillin / therapeutic use
  • Anti-Bacterial Agents / therapeutic use
  • Anti-Infective Agents / therapeutic use*
  • Drug Resistance, Bacterial
  • Drug Therapy, Combination
  • Female
  • Helicobacter Infections / drug therapy*
  • Helicobacter pylori*
  • Hong Kong
  • Humans
  • Lansoprazole
  • Levofloxacin
  • Male
  • Metronidazole / therapeutic use
  • Middle Aged
  • Ofloxacin / therapeutic use
  • Omeprazole / analogs & derivatives
  • Omeprazole / therapeutic use
  • Organometallic Compounds
  • Tetracycline / therapeutic use
  • Treatment Outcome


  • 2-Pyridinylmethylsulfinylbenzimidazoles
  • Anti-Bacterial Agents
  • Anti-Infective Agents
  • Organometallic Compounds
  • Lansoprazole
  • Metronidazole
  • Levofloxacin
  • Amoxicillin
  • Ofloxacin
  • Tetracycline
  • bismuth tripotassium dicitrate
  • Omeprazole