For second-line therapy of H. pylori infection, a ten-day tetracycline-levofloxacin (TL) quadruple therapy is more effective than amoxicillin-levofloxacin (AL) quadruple therapy. Investigators examined the efficacies of TL and AL quadruple therapy for H. pylori eradication.

Following the failure of first-line therapies, H. pylori-infected participants were randomized to receive either AL quadruple therapy (amoxicillin 500 mg four times a day [QID], levofloxacin 500 mg once a day [QD], esomeprazole 40 mg twice a day [BID], and tripotassium dicitrato bismuthate 300 mg QID) or TL quadruple therapy (500 mg tetracycline QID, 500 mg levofloxacin QD, 40 mg esomeprazole BID, and 300 mg tripotassium dicitrato bismuthate QID) for ten days. The post-therapy H. pylori status was checked six weeks following the end of therapy.

As per the intention-to-treat analysis, the TL quadruple group exhibited a better cure of  H. pylori infection than the AL quadruple group. Both TL and AL quadruple groups showed comparable frequencies of adverse events and drug adherence (Table 1).

Additional assessment illustrated that the TL quadruple treatment had a high elimination rate for both levofloxacin-resistant and susceptible strains (88.9% and 100%). Conversely, the AL quadruple treatment offers a high elimination for levofloxacin-susceptible strains (90.9%) but a poor elimination efficacy for the levofloxacin-resistant strains (50%).

Thus, TL quadruple therapy exhibits better efficacy than AL quadruple therapy for H. pylori elimination in a population having high levofloxacin resistance.