Objective: To identify the optimal dosage of levofloxacin to eradicate persistent Helicobacter pylori when triple therapy with amoxicillin, clarithromycin, and omeprazole fails. Methods: We investigated 124 patients whose triple therapy including clarithromycin had failed. Clarithromycin resistance was indirectly assessed by the 13C-urea breath test, with a post-treatment value cut-off point at 15. All patients were randomly divided into two groups, to receive 1-week amoxicillin 1 g and lansoprazole 30 mg twice daily, plus either levofloxacin 500 mg once (ALL-500 group) or twice daily (ALL-1000 group). Six weeks later, the 13C-urea breath test was repeated to assess whether H. pylori was eradicated. Results: Intention-to-treat (ITT) and per-protocol (PP) analysis showed no difference in H. pylori eradication rates in both the ALL-500 and ALL-1000 groups (ITT: 79% vs. 80.6%, p >.05; PP: 86% vs. 87.5%, p >.05). For both groups, the per-protocol H. pylori eradication rates were also similarly high between patients with a post-treatment value of 13C-urea breath test ≤ 15 and those with a value > 15 (ALL-500: 85% vs. 86.5%, p >.05; ALL-1000: 88.9% vs. 86.8%, p >.05). Conclusion: One-week levofloxacin 500 mg daily-based triple therapy is effective for eradicating the persistent H. pylori after a failed triple therapy with amoxicillin, clarithromycin, and omeprazole.
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