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欧洲幽门螺杆菌治疗共识 5

Failed eradication even after quadruple and levoflaxicin based therapy

After first line treatment, various "second line" treatments can be used. The policy for H.pylori is: Make sure the infection is real (breath test for follow-up). Always give a high dose of PPI (acid blocker) when using amoxicillin. In the second treatment, give a different drug in place of clarithromycin.

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Joined: Sat Sep 25, 2021 6:59 pm

Failed eradication even after quadruple and levoflaxicin based therapy

Post by vivekr64 »


I have had 4 treatments for H pylori over the last 10 years. I have visited two prominent Gastros' in Singapore , and after failure of a bismuth containing quadruple therapy, the gastro has prescribed a levoflaxicin based triple therapy.

Despite this the H PYLORI has persisted, and is giving me a peptic ulcer with daily pain and frustration. I am taking a high dose of probiotics to restore gut health, but it helps only partially

I am beginning to assume that i have a ultra-resistant form. I know that culturing the bacteria is the next step. But if that does not work, what are my options?

Please help

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Re: Failed eradication even after quadruple and levoflaxicin based therapy

Post by Helico_expert »

If you do not know what antibiotics have you used before, then indeed, culturing the H. pylori is the best way to find out what antibiotics should be used next to efficiently eradicate the nasty bacteria.

Otherwise, you can always try the following

high dose PPI, eg rabeprazole 20mg TID
high dose amoxicillin, 1g TID
high dose bismuth, 240mg QID

and one more antibiotic that you are less likely tried.
eg. rifabutin or furazolidone.

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